Fillable Online 477 23rd Street, Ogden, UT -84401 Fax Email 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the 'Full Name on Record' section. Ensure you include the first, middle, and last names accurately.
3. Provide the 'Date of Birth', 'City', 'County', and 'Hospital' where the individual was born. This information is crucial for processing your request.
4. Complete the sections for 'Parent 1' and 'Parent 2' with their full birth names, birth dates, and states or countries of birth.
5. Indicate if the person is deceased by selecting 'Yes' or 'No'.
6. Fill out your details as the individual making the request, including your name, telephone number, address, and relationship to the individual on the certificate.
7. Specify your reason for requesting the certificate and sign at the bottom of the form.
8. If mailing your request, ensure you print a complete mailing address below and include payment details as required.

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