Washington State Department of Health - Vital Records Forms · Washington state form
How to Register an Unattended Home Birth DOH 422-121
Instructions and forms for registering a Washington unattended home birth, including the birth filing, supporting affidavit, identity documents, and residence evidence.
- What this form is
- This packet explains how to register a child under one year old who was born at home without a licensed midwife or medical professional. It includes the Washington State Birth Filing form and Supporting Affidavit, along with identity and residence documentation requirements. The affidavit must be signed before a notary public, and the packet says forms must be postmarked before the child’s first birthday.
- Who needs it
- A parent or person with knowledge of the birth facts can use this packet to register an unattended home birth for a child under one year old.
- Why it needs a notary
- The Supporting Affidavit must be signed in the presence of a notary public. This signature can be notarized online with a commissioned online notary.
- How to submit it
- Send the completed forms and required documents to Attention: Birth Registration, Center for Health Statistics, PO Box 47814, Olympia, WA 98504-7814. Forms must be postmarked before the child’s first birthday.
Questions
Who can use this packet to register an unattended home birth?
It applies to a child under one year old born at home without the assistance of a licensed midwife or medical professional. The packet explains the forms and supporting documents required for registration.
Does the Supporting Affidavit need to be notarized?
Yes. The Supporting Affidavit must be signed in the presence of a notary public. This can be done online with a commissioned online notary.
Where do I send the completed forms and documents?
Send them to Attention: Birth Registration, Center for Health Statistics, PO Box 47814, Olympia, WA 98504-7814. The packet states the forms must be postmarked before the child’s first birthday.