Missouri DHSS - Vital Records Applications and Forms · Missouri state form
Application to Record Birth After 12th Birthday MO 580-0636
MO 580-0636 is used to apply to record a delayed birth for a person age 12 or older. The registrant and supporting affiant must sign before a notary.
- What this form is
- The Missouri Department of Health and Senior Services Bureau of Vital Records uses MO 580-0636 to record a birth after the registrant’s 12th birthday. The registrant and a supporting affiant must sign in the presence of a notary. The application requires two different supporting documents and should be used only after the Bureau issues a Statement of No Record following an Application for a Vital Record and search fee.
- Who needs it
- A person age 12 or older seeking to register a delayed birth in Missouri, with a supporting affiant older than the registrant, may use this application.
- Why it needs a notary
- Notarization is required: the registrant and supporting affiant must sign in a notary’s presence. This can be done online with a commissioned online notary.
- How to submit it
- Return the completed application and two different supporting documents by mail to DHSS - Bureau of Vital Records, 930 Wildwood Dr., Jefferson City, MO 65109. The form says documents must accompany the application.
Questions
Who can use the Application to Record Birth After 12th Birthday?
The instructions state that only a person who is now 12 years of age or older will use this form. It is for recording a delayed birth.
Is a notary needed for MO 580-0636?
Yes. The registrant and supporting affiant must sign in the presence of a notary public. This can be done online with a commissioned online notary.
What documents must accompany the application?
The instructions require two documents of different types to verify the registrant’s name, date of birth, and place of birth. One document must give the parents’ names.