Washington State Department of Health - Vital Records Forms · Washington state form
DOH 422-081 Application for Confidential Birth Information
Request eligible information from your own birth certificate’s confidential section using this application. Applicants must provide proof of identity and complete the form.
- What this form is
- Use this application to request certain items from the confidential section of your own birth certificate. The form asks for birth and applicant information. The document states that applicants must provide proof of identity and that a legal name-change document is required if the applicant’s name has changed since birth. Information about a person’s mother or father remains restricted.
- Who needs it
- A person seeking eligible information from the confidential section of their own birth certificate may use this application.
- Why it needs a notary
- If you are not applying in person, sign the application and have your signature notarized. This can be done online with a commissioned online notary.
- How to submit it
- Complete the application and send it with identification documents to the Center for Health Statistics, P.O. Box 47814, Olympia, WA 98504-7814.
Questions
Who can request confidential birth information with this application?
The document says you may request information only from your own birth certificate. It also says the information provided will be about you; information about your mother or father remains restricted.
Is a notary needed for this application?
If you are not applying in person, the document requires you to sign the application and have your signature notarized. This can be done online with a commissioned online notary.
What should I submit with the application?
The document says to send identification documents and the completed application. If your name has changed since birth, include a copy of a legal document showing the change, such as a marriage certificate or court order.