Birth Certificate Order Form

If you are a parent of the child, to receive a certificate you must be listed on the birth record as a parent. If you are Father/Parent B and not married to the Mother/Parent A, your name is added to the record by completing a Voluntary Acknowledgement of Paternity Affidavit. If you did not complete this form at the hospital or Deschutes County office, it is likely you are not listed as the Father/Parent B on the birth record and would be unable to receive the certificate. If you are unsure, we suggest that you do not place this order and have Mother/Parent A order instead. After you have read and understand this message, a checkmark in this box is required for you to proceed with this order.

I have read and understand.

Child on Record

First Name

Middle Name

Last Name

Date of Birth

Babies less than 6 months old only.

Sex

Male

Female

Place of Birth Communities in Deschutes County only.

Mother / Parent A

First Name

Middle Name

Your Last Name at Birth Legal name prior to first marriage.

Father / Parent B

First Name

Middle Name

Your Last Name at Birth Legal name prior to first marriage.

Customer Information

First Name

Middle Name

Current Legal Last Name

Mailing Address

City

State

ZIP Code

Daytime Phone Number

E-mail Address

Reason for ordering record

Relationship to child named above Visit https://bit.ly/OR-Eligibility to determine if you are eligible.

Social Security Number (SSN) SSN is to assist with identity verification only, and will not be stored on our servers.

Certification

By entering my full name in the space provided and transmitting this form electronically, I state that I am the applicant listed and the information provided by me within this web application is complete and accurate. In accordance with law ORS 432.380, only the person named on the record, immediate family members, legal representatives, and government agencies are eligible to access birth records. For all others, access to birth records is restricted for 100 years. WARNING: Providing false information is a felony under ORS 432.993.

Sign by typing your full name below.