Colorado Department of Public Health and Environment For Office Use Only

Vital Records Section HSVR-VR-A1 ID _____ Cash _____

4300 Cherry Creek Drive South ISS _____ CK _____
Denver, CO 80246-1530 CC _____
(303)692-2200 Other _____
www.cdphe.state.co.us/certs
SF# _____-____________

Application for Certified Copy of Birth Certificate

Colorado has birth records for the entire state since 1910. Certified copies of certificates are also available from county offices (see reverse side).

Requestor Information
Print name of person making request First Middle Last Reason for request:

Mailing Address City State Zip Daytime Phone

( )
Physical Address City State Zip Alt Phone Number
( )

Pursuant to Colorado Revised Statutes, 1982, 25-2-118 and as defined by Colorado Board of Health Rules and Regulations, applicant must have a direct and
tangible interest in the record requested. The penalties for obtaining a record under false pretenses include a fine of not more than $1,000.00, or imprisonment
in the county jail for not more than one year or both such fine and imprisonment (CRS 25-2-118)

PLEASE RETURN YOUR REQUEST WITH A PHOTOCOPY OF YOUR DRIVER’S LICENSE, STATE ID OR PASSPORT.
(To review the full list of primary and secondary identification, please visit www.cdphe.state.co.us/certs)
By signing below, I have read and understood that there are penalties for Relationship to Registrant (person Today’s date
obtaining a record under false pretenses. named on certificate) *see reverse side

Please submit proof of relationship

Registrant Information
Information about person whose birth certificate is being requested — please type or print.
If adopted, provide adoptive information and see special service on other side.
Full Name at Birth First Middle Last

Month Day Year Is this Person Deceased? ❒Yes ❒No If yes, date: ____/____/_______
Date of Birth
__ __ __ __ State Where Death Occurred: _________________________
Please provide certified copy of death certificate
City County State
Place of Birth
Colorado ONLY
Full Name of Father First Middle Last

First Middle Maiden Last Name (name prior to first marriage)

Full Name of Mother
❒ Check here if you are requesting a certificate of stillbirth
Ways to Order Charges
Apply in person for same-day service. Office hours are from 8:30 a.m. to 4:30
p.m., Monday–Friday. Cost of certificates:
Order certificate online** at www.cdphe.state.co.us/certs Certificate(s) $17.75 for 1st copy (or search when no record found) $
mailed 2-3 days after receipt of all required documentation.
$10 for each additional copy of same record ordered
Fax your application with credit card information**: within continental U.S. at same time ............................................................. $
fax 1-800-423-1108; outside continental U.S. fax 1-303-691-9307.
Certificate(s) mailed at the end of five business days upon receipt of all $9 credit card convenience charge (walk-ins excluded) $
required documentation.
Mail in application with check, money order, or credit card information. Make check $50 for each heirloom copy ..................................... $
or money order payable to Vital Records. Please do not send cash. Certifcate(s)
mailed within three weeks upon receipt of all required documentation. Please check one:
❒ Regular mail ($0.00 - no additional charge for regular
**$9.00 convenience charge to be added. mail)
❒ Fed Ex – within continental U.S. ($20.00)
❒ Express Mail – within continental U.S. ($18.30) $
Credit Card Orders** Total .............................................................................. $
Card Type: ❒ Visa ❒ Mastercard ❒ Discover ❒ American Express
Cardholder Name:___________________________________________ Number of standard copies
Number of heirloom copies
Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Total copies ordered
Exp. Date: _____/_________
**$9.00 convenience charge to be added. 12/10 bicert.pdf
*Certified copies of birth certificates may be issued to:
Please note that proof of relationship is required: (e.g. marriage certificates, birth certificates, court orders)
The registrant (person named on the certificate) Adult children or grandchildren of the registrant
Parents Stepchildren
Grandparents and Great grandparents Legal guardian
Stepparents Legal representatives of any of the above must present proof of client relationship
Siblings Consular Corps
Spouse Genealogists representing family members with appropriate credentials
Certified copies of certificates are available in the county where birth occurred. The following county offices can issue certified copies for birth occurring anywhere in Colorado for birth years 1910 to present.

COUNTY OFFICES: Fremont County Local Registrar Morgan County

Alamosa County Registrar Mr. Ray Woodard Northeast Colorado Health Department
Courthouse 611 Main Street 228 W. Railroad
402 Edison Avenue P.O. Box 872 Fort Morgan, CO 80701
P.O. Box 630 Canon City, CO 81215-0872 970-867-4918
Alamosa, CO 81101 719-275-1556 Fax: 970-867-0878
719-589-6681 Fax: 719-276-5123
Fax: 719-589-6118 rdwoodard1@yahoo.com Otero County Health Department
dheiman@alamosacounty.org 13 West Third Street, Room 111
Garfield County La Junta, CO 81050
Archuleta County 109 8th Street Suite 200 Phone 719/383-3040,
San Juan Basin Health Department Glenwood Springs, CO 81601 FAX 719/383-3060
P.O. Box 597 970-945-2377 x1950
Pagosa Springs, CO 801147 Park County Clerk and Recorder
970-264-4640 Grand County Courthouse 501 Main Street P.O. Box 220
308 Byers Ave. P.O. Box 120 Fairplay, CO 80440
Baca County Hot Sulphur Springs, CO 80451 phone 719.836.4333
Office of the Treasurer 970-725-3347 ext.110 fax 719.836.4348
741 Main Street Fax: 970-725-0100 email: pcclerk@amigo.net
Springfield, CO 81073
719-523-4302 Gunnison County Registrar Prowers County Nursing Service
Dept. of Public Health 1001 S. Main St P.O. Box 336
Bent County Nursing Service 225 North Pine St. Ste. E Lamar CO 81052
701 Park Avenue Gunnison, CO 81230 719-336-2606
Las Animas, CO 81054 970-641-0209 Fax: 719-336-2985
719-456-6042
Fax: 719-456-0518 Jefferson County Vital Records Pueblo County Health Department
dlucero@bcns.net Dakota Building 101 W. 9th St.
800 Jefferson County Parkway, Suite 1300 Pueblo, CO 81003
Boulder County Public Health Golden, CO 80401 719-583-4300 (press 4)
3450 Broadway 303-271-6450
Boulder, CO 80304 Fax: 303-271-6451 Rio Grande County
303-441-1100 Fax: 303-440-3984 Office of the Clerk and Recorder
Kit Carson County 965 6th Street, PO Box 160
Boulder County Public Health 251 16th Street Del Norte, CO 81132
529 Coffman, Suite 200 Burlington, CO 80807 719 -657-3334
Longmont, CO 80501 719-346-5950
303-678-6166 Fax: 303-678-6163 Routt County Northwest Colorado Visiting Nurses Assn.
La Plata County 940 Central Park Drive Suite 101
Broomfield Department of Health and Human Services San Juan Basin Health Dept Steamboat Springs, CO 80487
6 Garden Center 281 Sawyer Dr., Suite 300 9708791632
Broomfield, CO 80020 Durango, CO 81303
720-887-2270 970-247-5702 San Miguel County Registrar
Fax: 303-469-2110 Fax: 970-247-9126 Office of the Treasurer
P.O. Box 488
Chaffee County Lake County Telluride, CO 81435-0488
City of Salida 115 E 5th Street 970-728-4451
448 E. 1st Street, Ste. 112 PO Box 24
Salida, CO 81201 Leadville, CO 80461 Sedgwick County
719-486-0708 Sedgwick County Treasurer
Cheyenne County 315 Cedar, Suite 210
Cheyenne County Public Health Larimer County Health Department Julesburg, CO 80737
560 W. 6 N. 1525 Blue Spruce Drive 970-474-3473
PO Box 38 Fort Collins, CO 80524 Fax: 970-474-0954
Cheyenne Wells, CO 80810 970-498-6710
719-767-5616 Fax: 970-498-6715 Summit County Clerk & Recorder
Fax: 719-767-8747 P.O. Box 1538
Las Animas County Health Dept. Breckenridge, CO 80424
Crowley County Local Registrar 412 Benedicta Ave. 970-453-3475
603 Main, Ste 2 Trinidad, CO 81082-2095 Fax: 970-453-3540
Ordway, CO. 81063 719-846-2213
719-267-5222 Teller County Clerk & Recorder
Fax: 719-267-3114 Logan County 101 W. Bennett Ave.
Northeast Colorado Health Department P.O. Box 1010
Delta County Registrar 700 Columbine Cripple Creek, CO 80813
Office of the Clerk and Recorder Sterling, CO 80751-0316 719-689-2951
501 Palmer St. Ste. 211 970-522-3741 Fax: 719-686-8030
Delta, CO 81416-1796 Fax: 970-522-1412
970-874-2150 Tri County Health Department
Mesa County Health Department (Adams, Arapahoe and Douglas County)
Denver Vital Records 510 29½ Rd 6162 S. Willow Dr. Suite 100
605 Bannock Street PO Box 20000 Greenwood Village CO 80111
Denver, CO 80204-4507 Grand Junction, CO 81502-5033 303-220-9200
303-602-3660 970-248-6900 Fax: 303-221-2906
Fax: 303-602-3665 Fax: 970-248-6972
Karen.Armstrong@mesacounty.us Washington County NE Colorado Health Dept.
Eagle County Health and Human Services 150 Ash St.
P.O. Box 660 Moffat County Northwest Colorado Visiting Nurses Association Akron, CO 80720
551 Broadway 745 Russell St. 970-345-6562
Eagle, CO 81631 Craig, CO 81625 Fax: 970-345-6561
970-328-8840 9708248233
Weld County Health Department
Elbert County Montezuma Couny Clerk & Recorder 1555 N. 17th Avenue
33817 Blue Bird Lane 109 West Main, Room 108 Greeley, CO 80631
Elizabeth, CO 80107 Cortez, CO 81321 970-304-6410
303-646-4127 970-565-3728 Fax: 970-304-6412
Fax: 303-646-0446 Fax: 970-564-0215
Weld County Health Department
El Paso County Health Department Montrose County Clerk & Recorder 4209 WCR 24½
305 South Union Boulevard 320 S. 1st Street, Room 101 Longmont, CO 80504
Colorado Springs, CO 80910-3123 P.O. Box 1289 720-652-4240 ext 8842
719-575-8492 Montrose, CO 81402 Yuma County- Wray
Fax: 719-575-8493 970-249-3362 Yuma County 245 West 4th St
910 South Main Wray, CO 80758
Yuma, CO 80759 970-332-4431
970-848-3878 Fax: 970-332-0691
Fax: 970-848-5101
OPTION AVAILABLE FOR ADOPTIONS:
Sign below only if you wish "ISSUED PURSUANT TO ADOPTION" to appear on your certified copy of the birth certificate. Only an adoptive parent or adopted
person is eligible for this special service effective August 8, 2002.

Number of copies without "issued pursuant to adoption" requested:

Number of copies with "issued pursuant to adoption" requested: Signature of : x
adopted person adoptive parent
(relationship to registrant; check one)