Vital Records - Certificate Requests
Language:
English
Spanish
Department of Health and Human Services
Division of Public Health Vital Records
Language:
English
Spanish
APPLICATION FOR CERTIFIED COPY OF BIRTH RESULTING IN STILLBIRTH CERTIFICATE
The Office of Vital Records has been registering births for persons born in Nebraska since
1904
.
WARNING
Please view Nebraska Revised Statutes (Section 71-649) before requesting a record. It is a felony to obtain, possess, use, sell, furnish, or attempt to obtain any vital record for purposes of deception.
Your Information:
Your name must match ID name
First Name
Middle Name
Last Name
Suffix
Daytime Phone Number
Email Address
Is Physical Address an APO or International Address?
Yes
No
Physical Address
Address Line 1
Address Line 2
City
State
Zip Code
Full Legal Name
Street Address or Post Office Box Number
City or Town Name, other Principal Subdivision (i.e. Province, State, County, Etc.) and Postal Code (if known)
Country Name
Is Shipping Address an APO or International Address?
Yes
No
Shipping Address
Address Line 1
Address Line 2
PO Box
City
State
Zip Code
Full Legal Name
Street Address or Post Office Box Number
City or Town Name, other Principal Subdivision (i.e. Province, State, County, Etc.) and Postal Code (if known)
Country Name
A copy of your current Government Issued ID is required to continue with this application.*
Please review the acceptable forms of documents here:
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