1984- Current Birth Certificate Request Form, Ingham County,
Michigan
MIKE BRYANTON
INGHAM COUNTY CLERK
313 West Kalamazoo St., Lansing, MI. 48933
Phone: (517)483-6424 Fax: (517)483-6421
Please
print and complete the form below and mail or fax it to our office. Please
include all requested information and documentation. Missing information or
documentation will delay processing of your request. If you are ordering a
certificate by mail, please enclose a check or money order, payable to the
Ingham County Clerk. (We do not accept out-of-state checks.) If you are
ordering a certificate by fax, you must provide a Visa or Master Card number and
expiration date. Fees are $15.00 for the first copy and $8.00 for each
additional copy of the same record. The record(s) will be mailed to the address
you provide within 5 to 7 business days. NOTE: If your request is urgent,
we will process the request the day it is received (if received before 3:00 p.m.
est) and return it to you via USPS Express mail. The charge for this service is
$18.00 and will be charged to your credit card.
Attention
YOUR REQUEST CANNOT BE FILLED WITHOUT VALID ID. Please
include picture ID for one of the individuals named on the record. Birth
certificates are not public records and can only be released to the individual
on the record or one of the parents named on the record.
Request
for Birth Record
|
Last Name at Birth First Name Middle Name
|
||
| Birth Date of Person Named
Above: Place of Birth of Person Named Above:
|
Were this person’s parents married at time of this birth: Yes 1 No 1 | |
| Is the person named above adopted? Yes 1 No 1 | 1st Copy | $15.00 |
| Birth Name of Mother to Person Named Above:
|
Additional Copy $8.00 Each | |
| Name of Father to Person Named
Above:
|
Total Number of Copies Purchased?______ Expedite Fee $18.00 (Express Mail) |
|
| Total Amount Due | $ | |
| Name:
Daytime Contact Phone Number Street: City/State/Zip:: |
|
| Bill to: Visa or MasterCard ONLY 1 | Credit Card # |
| Check and or Money Order Enclosed
1
(We do not accept out-of-state check) |
Expiration Date: |