Southern Nevada Health District Birth Application (2) docx - southernnevadahealthdistrict 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name on Certificate' field with the child's full name, ensuring accuracy for official records.
3. Fill in the 'Date of Child's Birth' section with the exact date, formatted as MM/DD/YYYY.
4. Indicate your relationship to the child by checking the appropriate box, such as 'Mother', 'Father', or 'Legal Guardian'.
5. Complete the 'Name of Hospital or Facility' field where the birth occurred.
6. Specify the number of copies you wish to request and calculate the total amount enclosed based on provided fees.
7. Provide your personal information including name, address, email, and phone number for contact purposes.
8. Sign and date the application at the bottom to validate your request before submission.

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