APPLICATION FOR SEARCH AND CERTIFIED COPY OF BIRTH CERTIFICATE
Facts Concerning This Birth
Full name of child at birth___________________________________________Race_______Sex _____
Date of
Birth__________________________Place
of
Birth______________________________________,Oklahoma
(MO)
(Day)
(Year)
(County)
(City)
Full Name of Father____________________________________________________________________________
Full Maiden Name of
Mother_____________________________________________________________________
Signature of person
making this
application______________________________________________________Date_______________
If both parents names are not indicated on the original certificate
of birth and a "full copy" is desired it will be necessary to have the
signature of the mother, or the registrant if of legal age,
or if certificate is required for "adoption purposes" the signature of the
attorney
of record and a statement from him to that effect.
The above signature is by ( ) person
himself-herself ( ) next-of-kin ( )
authorized agent
Purpose for which this copy is needed
( ) School (
)Passport ( ) Employment
( ) Adoption ( ) Other
(Please state)_________________________________
Has copy of this person's birth certificate been received before? Yes( ) No( ) Known ( )
PLEASE PRINT CORRECT MAILING ADDRESS
BELOW: Number
of copies wanted @ $5.00 ___
Fee enclosed $___________
_____________________________________________________
(Name)
ENCLOSE A STAMPED
_____________________________________________________ SELF-ADDRESSED ENVELOPE
(Street
Address)
WITH THIS APPLICATION
_____________________________________________________
(City)
(State)
(Zip)