DARKE COUNTY HEALTH DEPARTMENT

300 GARST AVENUE

GREENVILLE, OHIO 45331

(937) 548-4196

 

REQUEST FOR CERTIFIED BIRTH CERTIFICATE

 

Name at Birth_________________________________________________________________

Date of Birth__________________________________________________________________

Mother’s Maiden Name___________________________________________________________

Father’s Name_________________________________________________________________

 

 

Signature of Person Making Application______________________________________________

Date__________Address: _______________________________________________________

Phone Number: ________________________________________________________________

 

Number Of Copies Requested: __________                        

 

**$23.00 per certified copy

**Please include money order payable to: Darke County Health Department
        Sorry, we cannot accept check or credit card payments.  We also cannot fax birth certificates.
        If requesting a certificate in person, we accept only cash, money orders, or checks with a valid driver's license identification.

**Please include a self addressed stamped envelope for the birth certificate to be mailed back to you.

 

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Page last updated: 3/11/2010