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
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Sr.
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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
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None
Jr.
Sr.
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Enter the exact hospital name. VitalChek selects a matching listed hospital, or enters the name under Other if it is not listed. Names are not shortened.
Is subject still living?
*
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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.
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V
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Name of Father: Select "unknown" If the father is unknown or was not listed on the birth certificate.
Father's Status
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×
Suffix
*
Select
None
Jr.
Sr.
I
II
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V
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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.
Complete all required fields in this section.