ALABAMA
REQUEST FOR CERTIFIED COPY OF ACKNOWLEDGMENT OF PATERNITY
The fee for a record search is $15.00, which includes the cost of one certified copy OR a Certificate of Failure to Find. For
additional copies of the same record ordered at the same time, the fee is $6.00 each. Make check or money order payable to
“State Board of Health.” Do not send cash. Fees are non-refundable. PRINT ALL INFORMATION LEGIBLY. You must
complete and sign the applicant section and provide valid identification (see reverse side) or your request cannot be
processed.
TAKE THIS FORM TO YOUR LOCAL ALABAMA COUNTY HEALTH DEPARTMENT OR MAIL THIS COMPLETED
FORM WITH VALID IDENTIFICATION AND APPROPRIATE FEE TO:
Alabama Department of Public Health, Center for Health Statistics, P.O. Box 5625, Montgomery, AL 36103-5625.
Visit our website at www.alabamapublichealth.gov/vitalrecords or call 334-206-5418.
Number of Copies
Amount Paid $ ________________________
FULL NAME OF CHILD ________________________________________________________________________________
First Middle Last
DATE OF BIRTH _________________________________________ SEX _______________________________________
COUNTY OF BIRTH ___________________________________ HOSPITAL _____________________________________
FULL NAME OF MOTHER
BEFORE FIRST MARRIAGE ____________________________________________________________________________
FULL NAME OF FATHER ______________________________________________________________________________
APPLICANT SECTION (THIS SECTION MUST BE COMPLETED) Acknowledgments of Paternity are restricted records. Valid
identification must be submitted with a request for a restricted record. You must be an immediate family member OR
demonstrate a legal right to the record in order to obtain a copy of the record (§ 22-9A-21). Anyone falsely applying for a
record is subject to a penalty upon conviction of up to three months in the county jail or a fine of up to $500. Code of Alabama
1975, § 13A-10-109.
By signing, you are certifying you have a legal right to the record requested.
Your Signature ________________________________________________________ Date __________________________
Print Your Name ______________________________________________________________________________________
Address _____________________________________________________________________________________________
City __________________________ State ________ Zip ____________ Daytime Phone (______)_____________________
Your Relationship to Child ______________________________________________________________________________
Reason for Request (if not immediate family) _______________________________________________________________
I allow the following individual to receive certificate(s) _________________________________________________________
ADPH-HS-21 Rev. 05/01/2019
IDENTIFICATION REQUIREMENTS FOR RESTRICTED ALABAMA VITAL RECORDS
Identification is required of any applicant requesting a restricted Alabama vital record (birth certificate
less than 125 years from the date of birth or death certificate less than 25 years from the date of death). The
applicant must submit a completed request and one form of identification from the Primary ID list below. In
the event the applicant is unable to provide identification from the Primary ID list, he/she may provide two
different forms of identification from the Secondary ID list.
If the applicant designates another individual to pick up a restricted certificate on his/her behalf, both
the applicant and the designee must provide acceptable identification.
The completed request, as well as a copy of all identification submitted, will be maintained by the vital
records office which processes the request.
Primary IDs Including PHOTO
(need at least one, current, expired no more
than 60 days)
Secondary IDs
(need at least two)
- Alabama Driver’s License
- Out-of-State Driver’s License
- State-Issued Non-Driver ID
- U.S. or Foreign Passport
- U.S. Certificate of Naturalization
- Certificate of Citizenship
- U.S. Military ID
-
Work ID (If applicant is employee of
agency/company making request)
- Alien Resident Card (Temporary or
Permanent)
- U.S. Employment Authorization Card
- Citizenship ID Card
- Tribal ID
- Pilot’s License
- Boating License
- Concealed Weapons License
- Ex-Felon ID
- Inmate ID issued by the U.S. Dept of
Justice w/ following documentation:
o Supporting documents from
institution if inmate is still in
custody, letter of release from
institution if inmate has been
released
- School ID (Must include current school
term)
- Alabama Voter Identification Card
- Expired, Government-Issued ID
- Utility Bill (No more than 6 months old)
- Work ID (If applicant is making personal
request)
- Vehicle Registration or Vehicle Title
- Property Tax Bill
- Military Discharge (DD Form 214)
- Voter Registration Card
- Health Insurance Card
- Social Security Correspondence (not
Card)
- U.S. Selective Service Card
- Recent DMV Receipt for Fines Paid
- Fishing or Hunting License
- Copy of Police Report or other official
documents which support theft, in cases
where individual’s ID has been stolen
- Autism Spectrum Card
- Immunization (Shot) Record
*In special cases where applicant is unable to
provide any of these documents, please contact
CHS at 334.206.5418.
