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18030 Foundation Drive, Suite A Noblesville, IN 46060 Phone: (317) 776-8500 Fax: (317) 776-8506 Charles Harris, MD Health Officer Instructions for Birth Certificate Request via Mail All persons born in Hamilton County after 1882 have a written birth certificate on file with the Health Department. These records are legal copies, which can be used for all requests, including school registration. Requests for these records are heavy during the mid to late August. To obtain a copy of a birth certificate, please complete the following: 1. Complete Application 2. Must Enclose Copy of Photo ID Driver’s License of person signing application) 3. Cash or Money Orders ONLY – No Personal Checks or Credit Cards FEE: $15 each 4. Self-Addressed Stamped Return Envelope For records of births outside of Hamilton County please contact the Indiana State Department of Health at www.in.gov/isdh Mail Request to: Hamilton County Health Department 18030 Foundation Drive, Suite A Noblesville, IN 46060 ---PAGE BREAK--- 18030 Foundation Drive, Suite A Noblesville, IN 46060 Phone: (317) 776-8500 Fax: (317) 776-8506 Charles Harris, MD Health Officer Application for search & certified copy of BIRTH RECORD WE HAVE HAMILTON COUNTY BIRTHS ONLY!!! PLEASE COMPLETE ALL ITEMS BELOW WARNING: False application to obtain or inspect, altering, mutilating, or counterfeiting Indiana Birth Certificates, or the use of such a certificate, is a criminal offense under IC16-37-1-12. In accordance with Indiana Code 16-37-1-7, requests for birth certificates must include the information below. A permanent record of this request must be kept on file. IDENTIFICATION IS REQUIRED IN ACCORDANCE WITH IC 16-37-1-8. FULL NAME AT Name after any legal changes or Court Ordered Paternity: Has this person been adopted? Yes No If so, give the name AFTER adoption: DATE OF BIRTH HOSPITAL/CITY WHERE HOW ARE YOU RELATED TO THE ABOVE PERSON? FULL MAIDEN NAME OF OF FULL NAME OF OF WHY DO YOU NEED THIS RECORD? HOW MANY COPIES? SIZE DO YOU WANT? REGULAR________ No Personal Checks – No Bills Over $20.00 A $1.00 PLUS 2% fee applies per Credit/Debit Card transaction Payment To Be Made By Cash/Money Order OR Credit/Debit Card(for in-office orders ONLY)_____ YOUR SIGNATURE YOUR NAME (Please PHONE # FOR OFFICE USE ONLY DATE