Birth Certificate Applications

Full Name(Required)

Date of Birth (Month, Day, Year)(Required)

Sex

Male

Female

NAME OF MOTHER (MAIDEN NAME)

NAME OF FATHER

PRINT NAME(Required)

Address

PHONE NUMBER(Required)

Signature

YOUR RELATIONSHIP TO PERSON(Required)

INTENDED USE(Required)

The fee for a birth record is $17.00 Additional copies are $9.00 each

Number certified copies requested(Required)

Date(Required)

Fulton County Health Department accepts cash, check, and debit/credit cards (ALLPAID charges a fee for debit and credit transactions).

Make checks payable to: FCHD or Fulton County Health Department