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Application for Certified Copy of BIRTH CERTIFICATE
                     Certified copies are computer generated and are valid for all legal purposes.

The law requires a fee of $15.00 for each copy issued. The fee must accompany the application. Records are
available from 1920 to current.

Make check or money order payable to: Livingston County Health Center.
Payments accepted: Personal Check, Money Order, or if applying in person, cash (correct change only).

                              Mail or bring this application and fee required to:
                                      Livingston County Health Center
                                      P. O. Box 973, 800 Adam Drive
                                           Chillicothe, MO 64601
Number of copies requested: ____

Name at birth ____________________________________________________________________________
                    First                   Middle                  Last

Could this record be recorded under any other name?             Yes       No

If yes, under what name?_____________________________________________________________________

Sex:      M      F

Date of Birth (Month/Day/Year)          _________/___________/_________

Place of Birth: City_______________________County __________________ State (Missouri Births Only)

Name of Father
                         First                         Middle                         Last

Name of Mother
                         First                         Middle                         Maiden

Printed name of person applying for certificate__________________________________________________

How are you related to the person on the certificate?_______________________________________________

Address of person applying:___________________________________________________________________

City_________________________State____________Zip_____________Daytime Phone (____)___________

Signature of person applying for certificate_______________________________________________________


FD: Jul 2007
                                                For Office Use Only

Date:_____________               Mail     Walk-in               Fee:   Cash           Check          M.O.
Certificate #_______________________by_______________________________________________________

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Application For Certified Copy Of Birth Certificat

  • 1. Application for Certified Copy of BIRTH CERTIFICATE Certified copies are computer generated and are valid for all legal purposes. The law requires a fee of $15.00 for each copy issued. The fee must accompany the application. Records are available from 1920 to current. Make check or money order payable to: Livingston County Health Center. Payments accepted: Personal Check, Money Order, or if applying in person, cash (correct change only). Mail or bring this application and fee required to: Livingston County Health Center P. O. Box 973, 800 Adam Drive Chillicothe, MO 64601 Number of copies requested: ____ Name at birth ____________________________________________________________________________ First Middle Last Could this record be recorded under any other name? Yes No If yes, under what name?_____________________________________________________________________ Sex: M F Date of Birth (Month/Day/Year) _________/___________/_________ Place of Birth: City_______________________County __________________ State (Missouri Births Only) Name of Father First Middle Last Name of Mother First Middle Maiden Printed name of person applying for certificate__________________________________________________ How are you related to the person on the certificate?_______________________________________________ Address of person applying:___________________________________________________________________ City_________________________State____________Zip_____________Daytime Phone (____)___________ Signature of person applying for certificate_______________________________________________________ FD: Jul 2007 For Office Use Only Date:_____________ Mail Walk-in Fee: Cash Check M.O. Certificate #_______________________by_______________________________________________________