Missouri DHSS - Vital Records Applications and Forms · Missouri state form
Application for Non-Certified Copy of Original Birth Certificate (580-3139)
Use this application to request a non-certified copy of an adoptee’s original birth certificate. Eligible applicants include the adoptee, the adoptee’s attorney, or a birth parent.
- What this form is
- The application requests identifying details about the adoptee, birth parents, adoption, and applicant. It includes a declaration under penalty of perjury and a signature section. A non-refundable $15 search fee must accompany the application, payable by check or money order to the Missouri Department of Health and Senior Services. The form states that a birth parent’s name must be listed on the certificate for its release.
- Who needs it
- An adoptee, the adoptee’s attorney, or a birth parent seeking a non-certified copy of the adoptee’s original birth certificate.
- Why it needs a notary
- The applicant’s signature must be notarized. The form includes a jurat and notary signature section; this can be done online with a commissioned online notary.
- How to submit it
- Mail the application with payment to the Bureau of Vital Records, P.O. Box 570, Jefferson City, MO 65102-0570, or submit it in the office in Jefferson City.
Questions
Who may apply for a non-certified copy of an original birth certificate?
The form identifies the adoptee, the adoptee’s attorney, or a birth parent as eligible applicants. It directs lineal descendants to use a separate application.
Does this application need to be notarized?
Yes. The application includes a jurat and notary signature section. The applicant’s signature can be notarized online with a commissioned online notary.
How do I submit form 580-3139?
The form says to mail the completed application with payment to the Bureau of Vital Records in Jefferson City or submit it in the office there. It requires a non-refundable $15 search fee.