Get Certificate Now Birth Certificate

	Certificate Information
Please enter the information that would be found on the certificate that you are requesting.
indicates mandatory fields for the application to be processed

First Name
Middle Name
Last Name
Date of Birth
Place of Birth (County and State)
	Burke, NC
	Other
County of Birth

Parent’s First Name
Parent’s Middle Name
Parent's Maiden Last Name

Parent’s First Name
Parent’s Middle Name
Parent's Maiden Last Name

	Requestor’s Info
Please enter this information about yourself.

First Name
Middle Name
Last Name
Last 4 digits of SSN
Confirm Last 4 of SSN

Home Phone
Daytime Phone (8am – 5pm)
Fax:
Email Address

Address1		Your relationship to the person whose name is on the certificate Self Spouse Sibling Child Parent Maternal Grandparent Paternal Grandparent Grandchild Authorized agent, attorney or legal representative of the person(s) listed.
Address2
City
State
Zip

Additional Notes About this Request

	Proof Of Identity
In order to process your request, YOU MUST provide a valid government issued photo identification of yourself. An example of a valid form of an ID is your drivers license. Selfies are not an acceptable forms of ID and will delay the request until a valid ID is provided. Please note that there is a 10 MB file size limit
Upload Identity Proof Image

Skip this step, I’ll e-mail/fax in my photo ID. Please make sure the subject line includes the word CONFIDENTIAL.

	Order Detail
All information on this site is provided in good faith, however we make no representation or warranty of any kind on lost or damaged packages. Under no circumstances shall we have any liability to you for loss or damages incurred by Fed Ex, UPS or United States Postal Service.

Item	Quantity
Number of Certified Copies
Number of Uncertified Copies

Delivery Method
Pickup at Register of Deeds Office
Mail
Express Mail (add $19.00)
International Express Mail (add $45.00)

Item	Price	Quantity	Total
Certified Birth Certificates
Uncertified Birth Certificates



Total : $0.00

I certify that all of the information provided on this application is true to the best of my knowledge. NOTE: IT IS A VIOLATION OF NORTH CAROLINA LAW (G.S. 130A-93) TO MAKE A FALSE STATEMENT ON THIS APPLICATION OR TO UNLAWFULLY OBTAIN A CERTIFIED COPY OF A VITAL RECORD.

I understand that an incomplete form will not be processed and that after 7 days my request will automatically be cancelled. I understand that when I submit my application an authorization of funds will be placed on my card for the amount that is being charged. The authorization ensures that the credit card account is in good standing with sufficient funds to complete the purchase. Once the Register of Deeds office fulfills the order the authorization will be captured and funds will be transferred from the credit card account. An authorization left uncaptured for 7 days will be automatically reversed. Occasionally, the bank issuing your credit card will show the authorization as an actual charge, but I understand that the charge is not settled until the office fulfills the order. I understand that my total charge includes an additional $3.50 convenience fee that is not retained by the Register of Deeds office

Enter your initials as an electronic signature acknowledging that you have read and agree to these terms

Birth Certificate Request

Certificate Information

Requestor’s Info

Proof Of Identity

Order Detail