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National Center for Health Statistics, CDC
Behavioral Risk Factor Surveillance System, CDC
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Vital Registration Forms
| Certificate Request Forms | |||
| Form Name | Purpose | Formats | |
| Birth Certificate | Request state certified copy of a Birth Certificate | PDF, HTML | |
| Death Certificate | Request a state certified copy of a Death Certificate | PDF, HTML | |
| Marriage Certificate | Request a state certified copy of a Marriage Certificate | ||
| Fax in Permission Slip | Grant permission for a third party to obtain a birth Certificate. For use in our walk-in office only. | ||
| 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) | ||
| Surname Affidavit | |||
| Affidavit to Correct Death Certificate | Used to Correct mistakes on the Non-medical section of a Death Certificate | ||
| Delayed Birth Certificate Packet | Provides Instructions on how to Register a Delayed Birth | ||
| 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. | ||
| 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 | ||
| Court Ordered Determination of Paternity | To be used by Circuit Courts to Summarize Court Ordered Paternity Determinations | ||
| Supply Request Form | (For Hospitals, Nursing Homes, County Clerks, etc)Request Supplies from Vital Registration | ||
| Hospital Report of Births and Deaths | Reports all births and deaths that occur in a facility per month to Vital Registration | ||
| 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 | ||
Page was last updated on Wednesday, July 6, 2011