Birth Certificate


	Birth Certificate Application NOTE: We only have records of births that occurred in Buffalo County or of a child whose mother was a Buffalo County resident at the time of child's birth. This form may be printed and the information required may be completed by hand. A signature is required before your application can be processed. Requestor must also supply a copy of his/her drivers license. 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: ___________________

16. Copy of Drivers License.