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_______________________________________________________