VITAL RECORDS

221 W CAPITOL AVE SOUTH DAKOTA

PIERRE SD 57501
605-773-4961
VITAL RECORDS REQUEST
vitalrecords.sd.gov
Instructions for completing this form are located on the back of this document.
Failure to follow these instructions may result in a significant delay in processing your request. Please read carefully.
Section 1: Complete with your own information.
YOUR FULL NAME ADDRESS (IF PO BOX, INCLUDE STREET ADDRESS OF RESIDENCE)

CITY STATE ZIP PHONE NUMBER

*4
YOUR SIGNATURE DATE

Section 2: For applicants applying by mail only

MAIL APPLICANTS ONLY: If copy of ID is not provided this application must be signed in front of a notary. Notary Seal
Signature of Notary Public: _____________________________________________________________________

Subscribed to and sworn before me this (date): ________________________

My commission expires: ________________________

Section 3: Provide the information for the record you are requesting. All copies are $15.00 each
BIRTH
FIRST NAME MIDDLE NAME LAST NAME
Male Female

DATE OF BIRTH CITY AND/OR COUNTY OF BIRTH # OF COPIES REQUESTED

PARENT A/MOTHER FIRST NAME MIDDLE NAME MAIDEN NAME (REQUIRED) LAST NAME

PARENT B FIRST NAME MIDDLE NAME MAIDEN NAME (IF APPLICABLE) LAST NAME (REQUIRED)

Your
Relationship: Child Parent Current Spouse Grandparent, grandchild over 18, or sibling only
Self Guardian Designated Agent Personal or Property Right Funeral Director, Attorney, or Physician

Type of Copy: Certified Informational Certified Photostatic Informational Photostatic

DEATH
FIRST NAME MIDDLE NAME LAST NAME
Male Female

DATE OF DEATH CITY AND/OR COUNTY OF DEATH # OF COPIES REQUESTED STATE FILE NUMBER

Your
Relationship: Child Parent Current Spouse Grandparent, grandchild over 18, or sibling only
Guardian Designated Agent Personal or Property Right Funeral Director, Attorney, or Physician

Type of Copy: Certified Informational Certified Photostatic Informational Photostatic

Please check one. Failure to do so will result in rejection of your application.

MARRIAGE DIVORCE
NAMES FIRST PERSON ON RECORD/SPOUSE A SECOND PERSON ON RECORD/SPOUSE B
FIRST, MIDDLE, MAIDEN NAME Male Female FIRST, MIDDLE, MAIDEN NAME Male Female
CURRENTLY ON
RECORD: CITY AND/OR COUNTY OF EVENT DATE OF EVENT (MM,DD,YY) # OF COPIES REQUESTED
(COMPLETE BOTH)
Your
Relationship: Child Parent Current Spouse Grandparent, grandchild over 18, or sibling only
Self Guardian Designated Agent Personal or Property Right Funeral Director, Attorney, or Physician

Type of Copy: Certified Informational Certified Photostatic Informational Photostatic

 DESIGNATED AGENTS
The individual who is designating an agent to collect their record must complete this section in addition to the application
and have their signature notarized.
I, _____________________________________________, after being duly sworn upon oath, do hereby authorize
________________________________________ to act as my designated agent to obtain certified copies of vital records.
Notary Seal
Signature of person designating an agent: _________________________________________
Signature of Notary Public: _________________________________________

Subscribed to and sworn before me this (date): _________________

My commission expires:____________________

SOUTH DAKOTA VITAL RECORD APPLICATION INSTRUCTIONS

ELIGIBILITY
By state law, vital records are not open for public inspection. Vital records may be issued in the form of a certified or an
informational copy. Only certain individuals are eligible to obtain a certified copy of a vital record.
• Self • Personal or Property Right - a right to the record not included in the
• Current Spouse categories above. Must submit documentation of the right with application.
• Parent • Funeral Directors, Attorneys, or Physicians - acting on behalf of the family.
• Child • Designated Agent - Must be given the authority by an individual to obtain
• Guardian - must submit documentation a vital record on his or her behalf.
of legal guardianship • Next of Kin - grandparents, grandchildren over 18, and siblings only.
Not qualified to receive a certified copy of a vital record?
Any person who submits an application, identification and the applicable fee can obtain an informational copy.

TYPE OF COPY
• Certified Copy - The copy is computer generated, issued on security paper with a raised seal, and has the signature
of the issuing agent.
• Informational Copy - The copy is issued on plain paper and contains the statement 'For informational Purposes Only.
Not for Legal Proof of Identification.' The copy does not contain a raised seal or signature of the issuing agent.
• Photostatic Copy (Certified or Informational) - The copy is a photocopy of the original record. This copy may be requested if
the computer generated copy does not contain the information needed. Generally, this copy is intended for geneology

ORDERING METHODS
Vital Records requests can be made using the following methods:
• Mail or in-person Requests can be processed at any South Dakota County Register of Deeds office or at the
State Vital Records office.
• A fee of $15.00 per record copy applies.
• Checks may be made out and sent to
VITAL RECORDS
221 W CAPITOL AVE
PIERRE SD 57501
• Applicants applying in-person must submit a clear copy of a current government issued photo ID that
contains the applicant's signature and expiration date.
• No government ID? Send a clear copy of any two of the following:
•Social Security Card •Car registration or title with current address
•Utility bill with current address •Pay stub (must include your name, social security number
•Bank statement with current address and the address of the business)
• Applicants applying by mail can have a notary public notarize their signature in SECTION 2 of the application.
• Internet
• Orders at www.vitalchek.com with a credit card in your name.
• A fee of $11.50 for expedited processing applies in addition to $15.00 per record copy.
• Telephone
• Orders at (605) 773-4961 with a credit card in your name.
• A fee of $11.50 for expedited processing applies in addition to $15.00 per record copy.