Issuance of Multiple Birth Certificates Report
Please use this form to report the issuance of four or more certificates for a birth record
in one transaction.
Print and email this completed form to [email protected] or
fax to 651-201- 5740, attn.: Brenda Shinaul.
Your Information (person submitting this report):
Name
County
Phone Number
Request Information:
Birth record state file number
Subject’s name
Subject’s date of birth
Mother’s full name
Father’s full name
Number of copies requested
Date of request
Requester name & relationship
revised 07/2012