6764-B Reisterstown Road, Baltimore, Maryland 21215-2026

1. Begin by accessing the form through our platform. Click ‘Get Form’ to open it in the editor.
2. Fill in the 'Date of application' field with the current date in the format Month/Day/Year.
3. Indicate the 'Number of copies of certificates requested' by entering the desired quantity.
4. Provide the 'Child’s name on fetal death certificate' as listed, ensuring accuracy for proper documentation.
5. Complete the 'Date of delivery' and 'Child’s sex' sections with relevant details.
6. In the 'Place of delivery' section, specify the hospital and county or Baltimore City where delivery occurred.
7. If known, enter the 'Child’s fetal death certificate number.'
8. Fill in both mother's full maiden name and married name accurately.
9. Enter father's name as required in the designated field.
10. Complete your mailing address to ensure proper delivery of your certificate.
11. Finally, sign where indicated to validate your request for a Certificate of Birth Resulting in Stillbirth.

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