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Please Enclose A Photocopy of Your Picture ID For Certified Copies

This document is an application form for requesting copies of vital records such as birth certificates, death certificates, and marriage licenses from the Register of Deeds office in Greensboro, North Carolina. The form requests the applicant's name, contact information, relationship to the individual on the record, number of copies needed, and requires a photocopy of a picture ID and signature certifying the information is true. It provides instructions on fees for certified versus uncertified copies and warns that making false statements is a felony.

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Jazzy Kate
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37 views

Please Enclose A Photocopy of Your Picture ID For Certified Copies

This document is an application form for requesting copies of vital records such as birth certificates, death certificates, and marriage licenses from the Register of Deeds office in Greensboro, North Carolina. The form requests the applicant's name, contact information, relationship to the individual on the record, number of copies needed, and requires a photocopy of a picture ID and signature certifying the information is true. It provides instructions on fees for certified versus uncertified copies and warns that making false statements is a felony.

Uploaded by

Jazzy Kate
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION FOR COPIES OF VITAL RECORDS

Return to: JEFF L. THIGPEN - REGISTER OF DEEDS


Post Office Box 3427 Post Office Box 1467
Greensboro NC 27402 OR High Point NC 27261-1467





Please enclose a photocopy of your picture ID for certified copies.

PLEASE PRINT OR TYPE
BIRTH CERTIFICATE Number of copies Full Size _________ Wallet _________

Full Name at Birth: ___________________________________________ FOR OFFICE USE
Date of Birth:________________________________________________
Father Full Name: ____________________________________________ Book __________
Mother Full Name (Maiden): ____________________________________ Page___________

DEATH CERTIFICATE Number of copies Full Size _________

Full Name of Deceased: _______________________________________ Book ___________
Date of Death: _______________________________________________ Page____________


MARRIAGE LICENSE Number of copies Full Size _________ Wallet _________

Full Name of Groom: _________________________________________
Full Name of Bride (Maiden) ____________________________________ Book___________
Date of Marriage: _____________________________________________ Page____________

The above certificate is: (Please circle your choice below)
1. Myself 8. Seeking information for legal
2. Spouse (Husband/Wife) determination of personal or property
3. Child/Stepchild rights
4. Brother/Sister 9. Authorized agent, attorney or legal
5. Mother/Father/Stepparent representative of the person listed above
6. Grandchild/Great-Grandchild
7. Grandparent/Great-Grandparent

I hereby certify that all of the information given is true to the best of my knowledge and belief.
(North Carolina General Statutes 130A-93 and 99)

Applicants Signature _____________________________________ Print Name_______________________________

Address: ______________________________________ City/State/Zip: ______________________________________

Email Address: _____________________________________________________________________________________

PLEASE ENCLOSE A PHOTOCOPY OF YOUR PICTURE ID. A PICTURE ID IS REQUIRED FOR
CERTIFIED COPIES.


WARNING: MAKING A FALSE APPLICATION FOR A VITAL RECORD
IS A FELONY UNDER STATE AND FEDERAL LAW.
Circle Type Requested: NOTE: Wallet size not acceptable for Social Security, Passport, etc
Certified Fee :$ 10.00 each Uncertified Fee In Person :$. 05 each
Uncertified Copies by Mail $1.00 each
.

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