1 - Requestor Information

What is your name?*
Your relationship to the person on the birth certificate*

2 - Birth Record Info

Date of birth*
Gender*
Was this person adopted?*
Full birth name (as listed on the certificate)
Mother's birth name
Father's full name
Child's adopted name
Adopted mother's birth name
Adopted father's full name

3 - Additional Info

Has your name ever changed?
Your current legal name*
Approx. date of Marriage*

4 - Where would you like the birth certificate shipped?

Is your billing address the same?
Billing address

5 - Secure Checkout - Michigan Certified Birth Certificate Application Filing

Processing*
Expiration Date