Michigan Birth Certificate Application Form

Birth information of the person on record

Please complete the birth information below as shown on the birth record. If you are applying on behalf of someone else (i.e. your child), please enter their birth information here.

Date of birth

Full name of the person on record

Please enter Full name at birth of the person on record as shown on the Birth Certificate.

Please enter the full name after adoption:

Adopted Mother/Parent’s full name

Please enter the adopted Mother/ Parent’s full name of the person on record.

Adopted Father/Parent’s full name

Please enter the adopted Father/ Parent’s full name of the person on record.

Please list the date and place of marriage

Date of marriage

Please include new full name after Marriage

Please include new legal full name after Court order

Your relationship with person on record

Mother/Parent’s full name

Please enter the Mother/Parent’s full name as shown on Birth Certificate of the person on record.

Father/Parent’s full name

Please enter the Father/Parent’s full name as shown on Birth Certificate of the person on record.

Contact information

Please enter your full name as shown on your ID and your contact information.

Delivery information

Please enter the physical address where you want the certificate to be delivered.