Birth Certificate Application

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***Please note that Morgan County only has birth and death records for people who were born or passed away within Morgan County, Indiana. If you are unsure whether the record exists in Morgan County, please call the office to verify: 765-342-6621.

AllPaid MUST be completed prior to filling out this form, and you must provide the AllPaid receipt transaction number to the correct field in this form. Upon completion of this form, you will be provided an email for where you must send a copy of the AllPaid receipt and your photo ID for your request to be completed.

WARNING: False applications, altering, mutilating or counterfeiting Indiana birth certificates is a criminal offense under IC 16-1-19-6.

* Denotes a required field

For Certificate

Application for Search of:*

Certified Copy of Birth ($18)

Certified Genealogy Copy of Birth ($5)

Certified Copy of Paternity Affidavit ($5)

Full Name at Birth (First, Middle, Last):*

Date of Birth:*

MonthDay Year,

Birthplace (County):*

Has this person been adopted?*

Yes

Please Do Not Complete The Following Field

If yes, has name been legally changed?*

Yes

If Yes, New Name (First, Middle, Last):

Full Name of Father (First Middle, Last):*

Father's State of Birth:

Full Maiden Name of Mother (First Middle, Last):*

Mother's State of Birth:

For Applicant:

Relationship to person on certificate:*

Record to be used for:

Name of Applicant:*

Address*

Address 2

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

Applicant's Phone

Phone Area Code-Phone 3-Phone 4 ext Extension

Applicant's E-mail*

By checking the box below, I hereby certify that I am the requestor named above and that I am authorized to request a certified copy of the record for the above named individual, in accordance with Indiana Code 16-37 and 410 Indiana Administrative Code 18. I understand that penalties are described by law for misrepresentation on this request.

I agree with the above statement:*

Yes

A Birth Certificate set costs $18.00 each (online). This includes one full size and one wallet-size certificate. You may purchase vinyl covers in full size and/or wallet-size for $2.00 each. Please indicate your choices and quantities below.

Number of Birth Certificate Sets ($18.00 each):*

Number of Protective Vinyl Sleeves- Full Size ($2.00 each):

Number of Protective Vinyl Sleeves- Wallet Size ($2.00 each):

Total Amount ($) Sent (Add amounts from 3 previous fields):*

AllPaid Transaction Number:*

If you would like the certificate mailed somewhere other than the above address, please print name and address of the person to whom the certificate is to be mailed:

Name:

Address

Address 2

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.

Birth Certificate Application

For Certificate

For Applicant:

Dialog Title