Alaska Vital Records Revision 07/2024
Alaska BIRTH Cerficate Request Form Instrucons
How to submit a request:
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Visit hps://www.vitalchek.com/ OR
Complete this form and submit it via mail, fax, or in-person. (Addresses, hours, and fax number are listed below)
Include payment and a copy of your ID.
Choose one method of submission. Please be advised that if you submit your requests via more than one
method, you will be charged for each request.
For all current fees and processing mes please visit our website: www.vitalrecords.alaska.gov
Who may obtain a birth cerficate?
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Parent(s) listed on the current cerficate.
Child listed on the cerficate (if 14 years or older) along with current school ID.
Legal Guardian with cerfied guardianship papers.
Third-Party requests must have notarized leer of consent for the release of informaon from the cerficate
holder or legal guardian.
Attorneys & government agencies must have a letter on their letterhead stating who they represent and
why the record is needed. Supporting original certified or notarized documentation must be provided.
Note: Faxed legal documents are NOT accepted.
Accepted forms of ID: (If expired, must be less than one year)
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Driver's license
State-issued ID
Passport
Military ID
Tribal/BIA card (with picture)
School ID
If you have none of the above forms of ID, please contact (907) 465-3391 for assistance
Mailing Address and Fax Number
Health Analycs and Vital Records
P.O. Box 110675
Juneau, Alaska 99811-0675
Fax orders: (907) 465-3618
Juneau Office
Walk-in Office Hours:
Mon – Fri, 8:30am – 4:30pm
5441 Commercial Blvd.
Juneau, Alaska 99801
Phone: (907) 465-3391
Anchorage Office
Walk-in Office Hours:
Mon – Fri, 8:30am – 4:30pm
3901 Old Seward Hwy, Ste. 101
Anchorage, Alaska 99503
Phone: (907) 269-0991
Please note: All changes to a birth certificate (including those related to paternity, adoption, legal name
changes, or other corrections) must be mailed or hand delivered as original documents and/or certified
copies of forms are required.
The standard processing time for these special services
is
3
months, expedited services are not available.
For additional information on how to amend a birth certificate, please contact our Special Services Unit at
(907) 465-1200.
Expedited service is only available online through hps://www.vitalchek.com/. Addional fees apply.
Alaska Vital Records Revision 07/2024
Alaska BIRTH Cerficate Request Form
Requests that do not include an applicant signature, copy of a government issued ID, and payment will not be processed. This form is only for the
purpose of the financial transacon and locaon of the requested record.
For expedited service, order through hps://www.vitalchek.com/
Applicant Informaon
Applicant name
Choose your relaonship to child named on the record:
Mailing name (if different)
Self
Parent
Email address
Legal representave (with documentaon)
Phone number
Purpose of request:
Mailing address
Personal records
(Street / PO Box)
Legal purposes
Other
(please specify)
(City, State, Zip)
Applicant signature (required)
Informaon needed to locate the record
Full name on the record
(first)
(middle)
(last)
Date of birth City or village of birth
Mother / Parent A’s
name prior to marriage
(first)
(middle)
(last)
Father / Parent B’s
name prior to marriage
(first)
(middle)
(last)
Order informaon
Count
Cost
Cerfied birth cerficates
($30 first copy, $25 each addional copy of the same record ordered at the same me)
$
Heirloom cerficates ($55 first copy; $50 addional copies)
Rie Munoz “The Embrace”
$
Jon Van Zyle “Polar Bears”
$
Paternity, correcon, adopon, or legal name change processing fee ($30)
$
Aposlle fee ($12 first copy, $2 each addional copy)
$
Aposlle country
Domesc shipping informaon (select one or call 907-465-3391 for informaon on internaonal shipping)
Regular mail (no fee, no tracking)
Priority mail with tracking ($10)
$
Priority mail with tracking and signature on delivery ($14)
This opon is recommended, Alaska Vital Records assumes no responsibility for items aer they have
been shipped. If documents are lost or stolen you will need to resubmit your order with ID and payment.
$
Total payment to be submied:
$
Did you sign above and include a copy of your ID?
Did you include legal documentaon if this request is not for yourself or your child?
Payment informaon
Check or Money Order (made out to Alaska Vital Records Office)
There will be a $30 NSF fee for returned checks.
Cash (walk-in ONLY)
Credit / Debit Card (We accept Visa, MasterCard, Discover, and American Express; complete informaon below)
Name on card
Expiraon date
Card number
Cardholder signature (required for CC)
Clear Form
Billing ZIP Code
0