Birth Certificate Order Form

Questions? Contact Vital Records at (541) 322-7498 or vitalrecords@deschutes.org.

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

Last Name

Use person's legal name at their birth, prior to first marriage.

Father / Parent B

First Name

Middle Name

Last Name

Use person's legal name at their birth, prior to first marriage.

Customer Information

First Name

Middle Name

Last Name

Mailing Address

City

State

ZIP Code

Daytime Phone Number

E-mail Address

Reason for ordering record

Relationship to child named above

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.