APPLICATION FOR CERTIFICATE OF BIRTH
KAREN S. COLE, CABELL COUNTY CLERK
VITAL STATISTICS DEPARTMENT
750 5th AVENUE-SUITE 108
HUNTINGT0N, WV - 25701
NOTE: A $5.00 search fee and self addressed
stamped envelope must accompany this
application. This fee includes one copy if found.
This fee is not refundable. Each additional copy
is$5.00 per copy. Payable to CABELLCOUNTY
CLERK.

QUANTITY

                        

FOR OFFICE USE ONLY
Cash
Check
M/O
No. Copies
AMOUNT
BIRTH

NAME
 

 FIRST
 		 MIDDLE
 		 MAIDEN
 

BIRTHDATE
 

 MONTH
 		 DAY
 		 YEAR
 

PLACE
 

 CITY
 		 COUNTY
 		 STATE
 

FATHER'S NAME
 

 FIRST
 		 MIDDLE
 		 LAST
 

MOTHER'S MAIDEN NAME
 

 FIRST

 		 MIDDLE

 		 LAST

 
 

WHAT IS YOUR RELATIONSHIP TO PERSON
NAMED ON CERTIFICATE?

                                                                  

SIGNATURE OF APPLICANT
 

                                                           

PLEASE PRINT, COMPLETE AND SIGN AND MAIL TO OUR OFFICE.