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STATE OF WYOMING Name as it appears on birth certificate

First Name __________________________________


APPLICATION FOR CERTIFIED COPY OF
BIRTH CERTIFICATE Middle Name ________________________________

This request must be accompanied by a fee of $13.00 per Last Name ___________________________________
copy. A money order or personalized check from the
person making the request should be made payable to
If this record could be recorded under any other name,
VITAL RECORDS SERVICES
list that name here
If you do not have a birth record on file, you will be sent
instructions for filing a Delayed Birth Certificate, and ______________________________________
your $13.00 fee will be retained as a searching fee.
Date of Birth Sex
_____/_____/____ Male Female
Enclosed is $________ for _____certified copy/copies

Place of Birth
Please enclose a self-addressed stamped envelope _____________________, WY
with the application.
Mother’s Full Maiden Name

WARNING: Wyoming Statute 35-1-431 states that it


is a criminal violation to, willfully and knowingly, use Full Name of Father
or attempt to use a birth certificate for any purpose
of deception.

Signature of Person Whose Certificate is Being


Requested or Parent Named on Certificate. If under
Requests must include a photocopy of the driver’s 18 years of age, signature of parent or legal guardian
license, state issued ID card, or passport of the person required. Legal guardian must submit a copy of guardianship
requesting the certificate. We will also accept a papers.
notarized signature of the person making the request.
X___________________________________________

Address to Which Copy is to be Mailed

____________________________________

____________________________________

PHOTOCOPY OF IDENTIFICATION ____________________________________

Mail your request to:

Vital Records Services


Hathaway Building
Cheyenne, WY 82002

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