Application for Certified Copy of Birth Certificate

This page has been automatically translated from English. MSDH has not reviewed this translation and is not responsible for any inaccuracies.

If you're pregnant or have a child under five years old, you can get free, healthy foods from our Women, Infants and Children's nutritional program if your income qualifies. (If you receive TANF, Food Stamps or Medicaid, you automatically qualify for WIC).

To apply for a copy of your birth certificate, please print the following application form:

• Application for Certified Copy of Birth Certificate PDF English
• Application for Certified Copy of Birth Certificate PDF Spanish/Español

Payment information and other instructions are below. Send completed application and payment to:

Mississippi Vital Records
P.O. Box 1700
Jackson, MS 39215-1700

Instructions

Before You Order

By Mississippi law, a portion ($1.00) of the fee collected for each certified copy is deposited in the Children's Trust Fund administered by the Mississippi Department of Human Services to fund programs to prevent child abuse and neglect.

• Complete all the information sections of the form. Please Print!
• Remember to sign the application.
• The certified copy of the birth certificate is available for $17 for the first copy and $6 for each additional copy ordered at the same time. This certified copy will satisfy claims requiring proof of dependency and situations where for family, historical or legal reasons additional information is required.
• A five year search of records on file will be made. If no record is found, a certification of Not-On-File will be issued. You will still be charged a fee for this certificate, but fees paid for any additional copies will be refunded.
• Only births recorded after November 1, 1912, are on file.

Photo ID Required

If you are applying for a birth certificate for yourself, a relative, or someone you legally represent, you must provide a copy of a valid photo identification with your application. Accepted forms of identification are:

• Photo driver's license
• State-issued photo ID
• Employment ID
• School, college or university ID
• US Military ID
• Tribal ID
• Alien registration/Permanent residence card
• Temporary resident card
• U.S. passport

Payment

• Send a personal check, bank or postal money order, or a bank cashier's check in the correct amount made payable to Mississippi Vital Records.
• We accept no responsibility for cash sent through the mail.
• Send completed application, appropriate fee and required photo identification to: Mississippi Vital Records
  P.O. Box 1700
  Jackson, MS 39215-1700

Failure to Receive

Complaints of failure to receive certified records will be honored within 6 months of the original request. If the copy was to be returned to you by U. S. Postal Service, please allow 4 weeks after mailing the request before inquiring. Inquiry about copies ordered with payment for special courier delivery should be made within 7 days of the request. Mail returned because of insufficient address or address changes will be re-mailed if this office is notified of the correct address within 6 months of request.

For more information, send e-mail to: VRInfo@msdh.ms.gov or call (601) 206-8200