Dandb businessdirectoryimperialcountyImperial County Public Health Department - El Centro , CA 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the 'Name on Birth Certificate' section. Fill in the first, middle, and last names as they appear on the certificate.
  3. Next, provide details about the birth location. Enter the 'County of Birth', 'City of Birth', and 'Date of Birth' in the specified format (Month, Day, Year).
  4. Complete the parental information by filling in 'Father's Name' and 'Mother's Maiden Name'.
  5. In the 'Name of Person Requesting Records' section, input your first, middle, and last name along with your mailing address including street number, city, state, and zip code.
  6. Indicate your relationship to the registrant by selecting one of the options provided. Ensure you check either authorized requestor or informational copy.
  7. Finally, sign and date the application at the bottom. If applying by mail as an authorized requestor, ensure your signature is notarized.

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