Sac_VitalRecordsApplication_SAC_Prod

Vital Record Application
Applicant's Information (Party Requesting Record):
Transaction Type
TransactionDateTime
Type a question
Name

First NameMiddle NameLast Name
Address

Street Address

CityState

Zip Code
Zip Code
Proof Of ID
(Driver's License #, ID #, etc...)
ID Expiration Date

MonthDayYear
Date
Phone Number
This information is for Internal use only and is not made available to the Public
If no record is found, a fee will be retained for searching as required by statute and a "certification of No Record" will be issued.

Online Application for Copy of a Vital Record
Vital Record Type
If no record is found, a fee will be retained for searching as required by statute and a "certification of No Record" will be issued.

Birth Certificate Information
B1
B-1.1
Identification
Birth Identification
B-1.2
Expiration Date
Identification Number Expiration Date B1
B-1.3
Phone NumberB1
Type of Copy
TypeofCopyB1Copy
NOTE: Informational Copy bears an inscription, specifying

"INFORMATIONAL. NOT A VALID DOCUMENT TO ESTABLISH IDENTITY"
Number of Copies
Child's First Name
First Name
Middle
Middle Name
Last
Last Name
NmType Primary
B-1.4
Sex
Sex
B-1.6
Date of Birth

MonthDayYear
Enter a valid date
DateFormatB1

MonthDayYear
Date
DateCopyB1
Nm Type Secondary
Secondary
Father's Name

First NameMiddle NameLast Name
Nm Type Tertiary
Tertiary
Mother's Name

First NameMiddle NameLast Name
If no record is found, a fee will be retained for searching as required by statute and a "Certification of No Record" will be issued.
ItemType1
In relationship to the persons whose authorized certified copies are requested, I am:
B-1.7
BC1RelSelValue
BirthCopy1
BC1RelReg
Relationship to Registrant
B-1.8
Declaration
I declare under penalty of perjury under the laws of the State of California, that I am an authorized person, as defined in California Health & Safety Code section 103526(c), and I am eligible to receive the authorized copy(ies) requested on this application form.
B-1.9 Accept
3.1.8.401~OP_OrderItemAdditionalInfo~FieldValues

B2
B-2.1
Identification
Identification Number
B-2.2
Expiration Date
Identification Number Expiration Date B2
B-2.3
Phone NumberB2
Birth Certificate Information
Type of Copy
TypeofCopyB2Copy
NOTE: Informational Copy bears an inscription, specifying

"INFORMATIONAL. NOT A VALID DOCUMENT TO ESTABLISH IDENTITY"
Number of Copies
Child's First Name
First Name
Middle
Middle Name
Last
Last Name
Nm Type Primary
B-2.4
Sex
Sex
B-2.6
Date of Birth

MonthDayYear
Enter a valid date
DateFormatB2

MonthDayYear
Date
DateCopyB2
Father's Name

First NameMiddle NameLast Name
Type a question
Secondary
Mother's Name

First NameMiddle NameLast Name
Type a question
Tertiary
If no record is found, a fee will be retained for searching as required by statute and a "certification of No Record" will be issued.
ItemType2
In relationship to the persons whose authorized certified copies are requested, I am:
B-2.7
BC2RelSelValue
BirthCopy2
BC2RelReg
Relationship to Registrant
Declaration
B-2.8
I declare under penalty of perjury under the laws of the State of California, that I am an authorized person, as defined in California Health & Safety Code section 103526(c), and I am eligible to receive the authorized copy(ies) requested on this application form.
B-2.9 Accept
3.2.8.402~OP_OrderItemAdditionalInfo~FieldValues

CopyType
B-3.1
Identification
Identification Number
B-3.2
Expiration Date
Identification Number Expiration Date B3
B-3.3
Phone NumberB3
Birth Certificate Information
Type of Copy
TypeofCopyB3Copy
NOTE: Informational Copy bears an inscription, specifying

"INFORMATIONAL. NOT A VALID DOCUMENT TO ESTABLISH IDENTITY"
Number of Copies
Child's First Name
First Name
Middle
Middle Name
Last
Last Name
Nm Type Primary
B-3.4
Sex
Sex
B-3.6
Date of Birth

MonthDayYear
Enter a valid date
DateFormatB3

MonthDayYear
Date
DateCopyB3
Father's Name

First NameMiddle NameLast Name
Type a question
Secondary
Mother's Name

First NameMiddle NameLast Name
Type a question
Tertiary
If no record is found, a fee will be retained for searching as required by statute and a "certification of No Record" will be issued.
ItemType3
In relationship to the persons whose authorized certified copies are requested, I am:
B-3.7
BC3RelSelValue
BirthCopy3
BC3RelReg
Relationship to Registrant
Declaration
B-3.8
I declare under penalty of perjury under the laws of the State of California, that I am an authorized person, as defined in California Health & Safety Code section 103526(c), and I am eligible to receive the authorized copy(ies) requested on this application form.
B-3.9 Accept
3.3.8.402~OP_OrderItemAdditionalInfo~FieldValues

Online Application for Copy of a Vital Record
Do you want to order another certificate?

Online Application for Copy of a Vital Record
The maximum number of requests for this type have been requested.
Max Request

Press Submit to complete your request

D1
D-4.1
Identification Number
D-4.2
Identification Number Expiration Date D1
D-4.3
Phone NumberD1
Death Certificate Information:
Type of Copy
TypeofCopyD1Copy
NOTE: Informational Copy bears an inscription, specifying

"INFORMATIONAL. NOT A VALID DOCUMENT TO ESTABLISH IDENTITY"
Number of Copies
Decedent's First Name
First Name
Middle
Middle Name
Last
Last Name
Nm Type Primary
D-4.3
Sex
D-4.5
Date of Death

MonthDayYear
Enter a valid date
DateFormatD1

MonthDayYear
Date
DateCopyD1
Father's Name

First NameMiddle NameLast Name
Nm Type Secondary
Mother's Name

First NameMiddle NameLast Name
Nm Type Tertiary
If no record is found, a fee will be retained for searching as required by statute and a "certification of No Record" will be issued.
ItemType4
Relationship to the Registrant
D-4.6
DC1RelSelValue
DeathCopy1
DC1RelReg
RelToReg
Relationship to Registrant
Declaration
D-4.7
I declare under penalty of perjury under the laws of the State of California, that I am an authorized person, as defined in California Health & Safety Code section 103526(c), and I am eligible to receive the authorized copy(ies) requested on this application form.
D-4.8 Accept
3.4.8.402~OP_OrderItemAdditionalInfo~FieldValues

D2
D-5.1
Identification Number
D-5.2
Identification Number Expiration Date D2
D-5.3
Phone NumberD2
Death Certificate Information:
Type of Copy
TypeofCopyD2Copy
NOTE: Informational Copy bears an inscription, specifying

"INFORMATIONAL. NOT A VALID DOCUMENT TO ESTABLISH IDENTITY"
Number of Copies
Decedent's First Name
First Name
Middle
Middle Name
Last
Last Name
Nm Type Primary
D-54
Sex
D-5.6
Date of Death

MonthDayYear
Enter a valid date
DateFormatD2

MonthDayYear
Date
DateCopyD2
Father's Name

First NameMiddle NameLast Name
Type a question
Mother's Name

First NameMiddle NameLast Name
Type a question
If no record is found, a fee will be retained for searching as required by statute and a "certification of No Record" will be issued.
ItemType5
Relationship to the Registrant
D-5.7
DC2RelSelValue
DeathCopy2
DC2RelReg
Relationship to Registrant
Declaration
D-5.8
I declare under penalty of perjury under the laws of the State of California, that I am an authorized person, as defined in California Health & Safety Code section 103526(c), and I am eligible to receive the authorized copy(ies) requested on this application form.
D-5.8 Accept
3.5.8.402~OP_OrderItemAdditionalInfo~FieldValues

D3
D-6.1
Identification Number
D-6.2
Identification Number Expiration Date D3
D-6.3
Phone NumberD3
Death Certificate Information:
Type of Copy
TypeofCopyD3Copy
NOTE: Informational Copy bears an inscription, specifying

"INFORMATIONAL. NOT A VALID DOCUMENT TO ESTABLISH IDENTITY"
Number of Copies
Decedent's First Name
First Name
Middle
Middle Name
Last
Last Name
Type a question
D-6.4
Sex
D-6.6
Date of Death

MonthDayYear
Enter a valid date
DateFormatD3

MonthDayYear
Date
DateCopyD3
Father's Name

First NameMiddle NameLast Name
Type a question
Mother's Name

First NameMiddle NameLast Name
Type a question
If no record is found, a fee will be retained for searching as required by statute and a "certification of No Record" will be issued.
ItemType6
Relationship to the Registrant
D-6.7
DC3RelSelValue
DeathCopy3
DC3RelReg
RelToReg
Relationship to Registrant
Declaration
D-6.8
I declare under penalty of perjury under the laws of the State of California, that I am an authorized person, as defined in California Health & Safety Code section 103526(c), and I am eligible to receive the authorized copy(ies) requested on this application form.
D-6.8 Accept
3.6.8.402~OP_OrderItemAdditionalInfo~FieldValues

Online Application for Copy of a Vital Record
Do you want to order another certificate?

M2
M-8.1
Identification
M-8.2
Identification Number Expiration Date M2
M-8.3
Phone NumberM2
Marriage Certificate Information
Type of Copy
Type of Copy
TypeofCopyM2Copy
NOTE: Informational Copy bears an inscription, specifying

"INFORMATIONAL. NOT A VALID DOCUMENT TO ESTABLISH IDENTITY"
Number of Copies
Name of first party
First Name
Middle Name
Middle Name
Last Name
Last Name
Type a question
Type a question
Name of second party
First Name
Middle Name
Middle Name
Last Name
Last Name
Date of Marriage
Date of Marriage

MonthDayYear
Date
DateFormat

MonthDayYear
Date
MarrageDateCopyM2
If no record is found, a fee will be retained for searching as required by statute and a "certification of No Record" will be issued.
ItemType8
In relationship to the persons whose authorized certified copies are requested, I am:
M-8.6
MC2RelSelValue
MrgCopy2
MC2RelReg
Relationship to Registrant
Declaration
I declare under penalty of perjury under the laws of the State of California, that I am an authorized person, as defined in California Health & Safety Code section 103526(c), and I am eligible to receive the authorized copy(ies) requested on this application form.
M-8.7

M3
M-9.1
Identification
M-9.2
Identification Number Expiration Date M3
M-9.3
Phone NumberM3
Marriage Certificate Information
Type of Copy
Type of Copy
TypeofCopyM3Copy
NOTE: Informational Copy bears an inscription, specifying

"INFORMATIONAL. NOT A VALID DOCUMENT TO ESTABLISH IDENTITY"
Number of Copies
Name of first party
First Name
Middle Name
Middle Name
Last Name
Last Name
Nm Type Primary
Type a question
Name of second party
First Name
Middle Name
Middle Name
Last Name
Last Name
M-9.4
Date of Marriage

MonthDayYear
Date
DateFormat

MonthDayYear
Date
DateCopyM3
If no record is found, a fee will be retained for searching as required by statute and a "certification of No Record" will be issued.
ItemType9
M-9.6
MC3RelSelValue
MrgCopy3
MC3RelReg
Relationship to Registrant
Declaration
I declare under penalty of perjury under the laws of the State of California, that I am an authorized person, as defined in California Health & Safety Code section 103526(c), and I am eligible to receive the authorized copy(ies) requested on this application form.
M-9.7

Should be Empty:

Vital Record Application

Applicant's Information (Party Requesting Record):