Application for Certificate of Birth Resulting in Stillbirth - Nebraska 2026

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  1. Click ‘Get Form’ to open the Application for Certificate of Birth Resulting in Stillbirth in the editor.
  2. Begin by entering the full name of the child in the designated field. Ensure accuracy as this is a vital record.
  3. Next, input the month, day, and year of stillbirth. This information is crucial for record-keeping.
  4. Fill in the city or town and county where the stillbirth occurred. This helps local authorities track records accurately.
  5. Provide both parents' full names. The father/parent’s name should be entered first, followed by the mother/parent’s name at birth.
  6. Indicate the purpose for which this record will be used. This section may require thoughtful consideration based on your needs.
  7. Clarify your relationship to the person listed on the record to validate your request.
  8. Sign and print your name at the bottom of the form, along with your address, telephone number, email address, and today’s date.
  9. Remember to enclose a photocopy of your photo ID when mailing in this request to ensure processing.

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Full name, date of birth and place of birth. Identification: Not all orders require this, but you may need a valid government-issued ID (e.g., drivers license, passport).
Your midwife or hospital social worker will provide you with a Birth Registration Form while in hospital and you have 60 days to register your babys birth in your state. The records will show the baby as stillborn and you will not need to register the death of your baby. It is free to register the birth.
Yes. The CBRS/CoS is a commemorative document that recognizes the life of a stillborn baby since they sadly do not receive an official Birth Certificate. The Fetal Death Certificate (FDC) is a required form the hospital fills out and sends to the state health department. The FDC often needed to apply for a CBRS/CoS.
Youll need to give the register office the Medical Certificate of Stillbirth that was issued to you by your doctor or midwife.
To get a birth certificate by mail, send a $17.00 check or money order made out to Vital Records (no credit cards). Include the following information: Childs full name on record. If adopted, list adoptive name and state adopted

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A Certificate of Stillbirth is a document issued by the State Vital Records Office only. It may be issued at the request of a parent of a stillborn fetus that docHubed at least twenty weeks gestation and died before birth. It is a commemorative document acknowledging the stillbirth.
Stillbirth is when a pregnancy goes beyond 24 weeks, but the baby dies before it is born. By law stillbirths must be registered within 42 days. The still birth can be registered by: mother of the baby.

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