ADOPTED? Please visit our FAQ section for important information.
Current name of subject: Enter the subject's current name here. If the name printed on the birth certificate differs, enter that exact recorded name in the separate fields below.
Suffix
*
Select
None
Jr.
Sr.
I
II
III
IV
V
×
Name on the birth certificate: If the current name, maiden name, adoption or legal name change makes the recorded name different or uncertain, enter the exact name printed on the certificate below. Do not infer it from a maiden or original name. Leave these fields blank only when the subject name above is also the recorded name.
Leave blank if no middle name appears on the certificate.
Suffix Exactly on Birth Certificate
*
Select
None
Jr.
Sr.
I
II
III
IV
V
×
Gender
*
Select
Male
Female
Nonbinary
×
Is subject still living?
*
Select
Yes
No
×
Name of Mother: Please enter both the current last name and the maiden last name of the mother.
Suffix of Mother
*
Select
None
Jr.
Sr.
I
II
III
IV
V
×
Name of Father: Select "unknown" If the father is unknown or was not listed on the birth certificate.
Father's Status
*
Select
Known
Unknown
×
Suffix
*
Select
None
Jr.
Sr.
I
II
III
IV
V
×
Leave blank if no first name appears on the certificate. Do not guess or invent a name.
Leave blank if no last name appears on the certificate. Do not guess or invent a name.
I confirm the subject's and parents' names are correct, including any matching or different last names
*
VitalChek may ask you to confirm matching or different parent and subject last names. Check this only after reviewing the names above.
I confirm my current legal name and the name on the birth certificate are both correct
*
VitalChek may ask a female certificate holder to confirm that the current legal name and the birth-certificate name are correct before continuing.
Complete all required fields in this section.