Health Statistics Center
350 Capitol Street, Room 165
Charleston, WV 25301-3701
(304) 558-2931
West Virginia Health Statistics Center, Providing Statistical Information for Informed Decisions
West Virginia Health Statistics Center, Providing Statistical Information for Informed Decisions
350 Capitol Street, Room 165
Charleston, WV 25301-3701
(304) 558-2931
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National Center for Health Statistics, CDC

Behavioral Risk Factor Surveillance System, CDC

Vital Chek® Networks, Vital Records Expediting service

Vital Registration Forms

Certificate Request Forms
Form Name Purpose Formats
Birth Certificate Request state certified copy of a Birth Certificate PDF
Birth resulting in Stillbirth Certificate Request a state certified copy of a Birth resulting in a Stillbirth Certificate PDF
Death Certificate Request a state certified copy of a Death Certificate PDF
Marriage Certificate Request a state certified copy of a Marriage Certificate PDF
Fax in Permission Slip Grant permission for a third party to obtain a birth Certificate.  For use in our walk-in office only. PDF

Corrections/Amendments Forms
Form Name Purpose Formats
Affidavit to Correct Birth Certificate Used to Correct Mistakes on an Adult's Birth Certificate PDF, DOC
Affidavit to Correct a Minor Child's Birth Certificate Used to Correct Mistakes on Children's Birth Certificates (under age of 18) PDF
Surname Affidavit
Affidavit to Correct Death Certificate Used to Correct mistakes on the Non-medical section of a Death Certificate PDF
Delayed Birth Certificate Packet Provides Instructions on how to Register a Delayed Birth PDF
Affidavit of Non-Paternity Used by the mother and her husband or ex-husband to attest that the husband or ex-husband is not the biological father of a child.  See our paternity page for more information. PDF
Paternity Affidavit Used by an unmarried mother and the biological father to place to establish paternity.  See our paternity page for more information. Call
Other Forms
Form Name Purpose Formats
Certificate of Adoption Form To be used by Circuit Courts to summarize Court Ordered Changes to Birth Certificates Due to Adoptions PDF
Court Ordered Determination of Paternity To be used by Circuit Courts to Summarize Court Ordered Paternity Determinations PDF
Supply Request Form (For Hospitals, Nursing Homes, County Clerks, etc)Request Supplies from Vital Registration PDF
Hospital Report of Births and Deaths Reports all births and deaths that occur in a facility per month to Vital Registration PDF
Disinterment/Reinterment Application for issuance of a permit to a licensed funeral director for the disinterment and reinterment of a previously interred dead human body from the original place of final disposition to another location in accordance with WV 64 CSR 32.10.2 PDF


Page was last updated on Wednesday, May 27, 2015