Birth Certificate Application


NOTE: We only have records of births, deaths, and marriages that occurred in Buffalo County.

This form may be printed and the information required may be completed by hand.  A signature is required before your application can be processed.

Penalties:  Any person who willfully and knowingly makes false application for a birth certificate shall be fined not more than $10,000 or imprisoned not more than 2 years or both.

 Return form using one of the following methods:

MAIL TO:
Buffalo County
Register of Deeds
PO Box 28
Alma, WI  54610-0028

FAX TO:
Buffalo County
Register of Deeds
at
(608) 685-6213

IN PERSON AT:
Buffalo County
Register of Deeds Office
407 South Second Street
Alma, WI  54610

 
Charges:  First copy of each record $20.00 - additional copies of the same record are $3.00 each.

1. Number of Copies Wanted:  _______

2.  Requestor Name:  ________________________      3.  Daytime Phone Number:  _________________

4.  Requestor Signature:  ______________________________________

5.  How is the requestor related to the person on the record (Please circle one of the following):


SELF    SPOUSE    PARENT    LEGAL CUSTODIAN    CHILD    BROTHER    SISTER    GRANDPARENT

              6. Mail Records to:

    Name:  ________________________________________________

    Address:  ______________________________________________

    City:  ___________________ State: ______  Zip: ______________

 

The Following Information Must Be Supplied By The Requestor:

7.  Date of Birth:  _______________  8. Place of Birth:  ________________

9. County of Birth: ________________  10.  Sex: MALE or FEMALE

11.  Name at Birth:  First  _________________ Middle  _________________ Last  ___________________

12.  Last Name of Father:  ____________________  13. First Name of Father:  _____________________

14. Maiden Name of Mother:  ___________________  15. First Name of Mother:  ___________________