(Rev: 8/2016)
Brown County Health
Department
Vital Statistics
Records Request Instructions
Notice to All
Vital Statistics
Customers:
Pursuant to Ohio Revised Code 3705.29, it is unlawful to purposely obtain, possess, use, sell, furnish, or
attempt to obtain, possess, use, sell, or furnish to another for the purpose of deception any certificate,
record, or certified copy of it that relates to the birth of another person, whether living or dead.
Who Can Order A Record:
Vital records (records of births, deaths, and fetal deaths) are public records in Ohio. This means that anyone who can
submit the basic facts of a record may request a copy.
Placing An Order:
For the fastest response, we recommend placing your order in person. See our website at
www.browncountyhealth.org or www.odh.ohio.gov/vs or call our customer service team at (614) 466-2531 for
detailed instructions and further explanation of these options.
Please complete one application form for each record or search requested. Please submit your applications with all
available identifying information. If you do not have sufficient information to allow us to identify the certificate, you
may request a search be performed rather than requesting a certified copy of the record.
Birth Certificates:
Please complete the “Record Information” portion of the application with the information as you believe it to be listed
on the original birth record. If there have been any changes to the name of the person on the record, also provide the
new name. Please identify the parents on the record as “mother”, “father”, or “parent”, and provide their names prior
to their first marriage (also known as maiden name). Birth records will be issued as certified abstracts unless you
indicate that you are requesting the certified copy for the specific purposes of obtaining dual citizenship, international
marriage or legal proceedings, or genealogy.
Death Certificates and Social Security Numbers:
As of October 15, 2015, for the first five years after the date of death the social security number of the deceased will not
be included on the death certificate unless the requestor is:
• The deceased’s spouse, or lineal descendant
• The deceased’s executor, attorney, or legal agent
• A representative of an investigative government agency
• A private investigator
• A funeral director (or agent responsible for disposition of
the body) acting on behalf of the deceased’s family
• A veteran’s service officer
• An accredited member of the media
Individuals requesting a death certificate with the social security number included must indicate on their application
that they are requesting the SSN be included and submit satisfactory identification to the registrar or clerk.
Satisfactory identification can be one of the following: Driver’s License, State ID, Birth Certificate, Marriage License,
Divorce Decree, and other forms of photo identification satisfactory to the Local Registrar.
Fees:
In accordance with section 3705.24 of the Ohio Revised Code we are required by law to charge a fee for each certified
copy of a vital record issued. The fee at this office for each certified copy of a birth, death, or fetal death record is
$25.00 per certified copy.
(Rev: 8/2016)
Brown County Health Department
APPLICATION FOR CERTIFIED COPIES
RECORD INFORMATION: (Information about the person you are requesting the record for)
Full names on birth or death certificate:
First Middle Maiden/Last
If name was changed since birth, indicate new name:
(i.e. adoption, legal name change, paternity, etc.)
Date of Birth: and/or Date of Death:
□ Mother
□ Father
□ Parent
Full First Full Middle Maiden or Last Name
□ Mother
□ Father
□ Parent
Full First Full Middle Maiden or Last Name
CHARGES: If ordering by mail, please include a business check or money order (do not send cash or personal check)
made payable to Brown County Health Department. We only accept credit/debit for online orders.
Birth:
If you do not need a birth certificate for any of the following reasons, skip
this section. Otherwise please indicate what the certificate is needed for:
□ Dual Citizenship □ Genealogy
□ Out of County Marriage □ International Legal Business
Number of copies requested:
______ x $25.00 = $__________
Death:
All death certificates will be issued without a social security number
unless identification is provided confirming you are one of the below
listed authorized requestors:
□ The deceased’s spouse or descendent
□ The deceased’s executor, attorney, or legal agent
□ A representative of investigative government agency
□ A private investigator
□ A funeral director (or agent responsible for disposition of the body) acting on
behalf of the deceased’s family
□ A veteran’s service office
□ An accredited member of the media
You must attach a copy of your identification showing you are an
authorized requestor along with a copy of a valid driver’s license.
Number of copies requested:
______ x $25.00 = $__________
Fetal Death:
Number of fetal death record
copies requested:
______ x $25.00 = $___________
Total Amount Due:
$_______________
PURCHASER’S INFORMATION: (Information about the person requesting the record)
Please print clearly as this will be used for your receipt, mailing address, and/or for future contact to complete your record request.
MAILING ADDRESS
Send completed application with required fee to:
826 Mt. Orab Pike
Georgetown, OH 45121
FOR OFFICE USE ONLY:
Purchaser’s
Name:
Email:
Street Address:
Phone Number:
City, State, & ZIP:
Purchaser’s
Signature:
Audit Number:
Date:
State File Number:
Burial Permit Number:
Payment:
Receipt Number: