Ar Birth Certificate Form PDF Details

The Arkansas Department of Health Vital Records plays a pivotal role in maintaining the integrity and accessibility of birth records within the state. Operating out of Little Rock, the office meticulously records only Arkansas births, holding a substantial but limited archive dating back to before February 1, 1914. Individuals seeking a birth certificate, whether for legal, personal, or genealogical purposes, encounter a standardized process and a fee structure designed to facilitate requests while covering associated expenses. An initial copy of the birth certificate is priced at $12.00, with each subsequent copy of the same record available for $10.00. These fees underscore the operational prerequisites of handling, searching, and delivering vital records. Applicants are prompted to furnish detailed information, including potential names and birth dates under which the certificate might be registered, to expedite the search. Moreover, the application mandates the inclusion of a photo ID and specifies the non-refundable nature of the search fee, reinforcing the department’s commitment to thoroughness in record verification. Accommodations for expedited service via internet, telephone, or walk-in orders indicate a responsiveness to public needs for swift document retrieval, while a stark warning against falsification underscores the legal gravitas of these documents. Through this multifaceted approach, the Arkansas Department of Health Vital Records ensures the orderly and reliable issuance of birth certificates, balancing public accessibility with procedural integrity.

QuestionAnswer
Form NameAr Birth Certificate Form
Form Length1 pages
Fillable?Yes
Fillable fields22
Avg. time to fill out4 min 39 sec
Other namesar birth, ar application printable, arkansas birth certificate application form, ark birth certificate

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ARKANSAS DEPARTMENT OF HEALTH

 

 

VITAL RECORDS, Slot 44

Date

 

4815 West Markham Street

 

 

Little Rock, AR 72205

 

 

BIRTH CERTIFICATE APPLICATION

Only Arkansas births are recorded in this office. There are a limited number of birth records filed in this office prior to February 1, 1914. The fee is $12.00 for the first copy ordered and $10.00 for each additional copy of the same record. The fee must accompany the application. Send check or money order payable to the Arkansas Department of Health. DO NOT SEND CASH. Of the total fee you send, $12.00 will be kept to cover search charges if no record of the birth is found. Only the names and dates listed will be searched for the $12.00 fee. Names and other dates submitted later will require an additional $12.00 non-refundable fee. Mail this application, a copy of your photo id and the money to the address above. Please allow 4-6 weeks for delivery.

List Below All Possible Birth Dates and Names Under Which the Certificate May be Registered. (Type or Print)

1 Full Name at Birth

First Name

Middle Name

 

 

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

Date of Birth

Month

Day

Year

 

Sex

Age Last Birthday

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City or Town

County

 

State

 

3.

Place of Birth

 

 

 

 

 

 

Name of Hospital or Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

Full Name of

First Name

Middle Name

 

 

Last Name

 

 

 

 

 

 

 

 

Father

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Full Maiden Name

First Name

Middle Name

 

 

Last Name

 

 

of Mother (Name

 

 

 

 

 

 

 

Before Marriage)

 

 

 

 

 

 

If this child has been adopted, please give original name if known.

If this is a delayed certificate, when was it filed?

What is your relationship to the person whose certificate is being requested?

What is your reason for requesting this certificate?

Is the person whose certificate is being requested still living?

Yes

No

Signature and telephone number of person requesting this certificate.

X

All requests for certificates require photo identification.

Certificates may also be ordered by the following methods:

Internet: www.vitalchek.com. All internet orders are expedited. The service fee and the certificate fee are charged to your debit or credit card (Visa, Master Card, Discover or American Express). Overnight shipping is available for an additional fee.

OR

Telephone: Toll free (866) 209-9482. All telephone orders are expedited. The service fee and the certificate fee are charged to your debit or credit card (Visa, Master Card, Discover or American Express). Overnight shipping is available for an additional fee.

OR

Walk-in: You may order a certified copy of the birth record by coming into this office. Orders are accepted for same day issuance from 8:00 A.M. until 4:00 P.M. Monday through Friday.

The office is located at 4815 West Markham St. Little Rock, AR 72205. Please order family history and genealogy by mail or internet.

Please PRINT the name and address of the person who is to receive this request on the line below.

HOW MANY

1st copy costs $12.00

Each additional copy costs $10.00

AMOUNT OF MONEY ENCLOSED $

Any person who willfully and knowingly makes any false statement in an application for a certified copy of a vital record filed in this state is subject to a fine of not more than ten thousand dollars ($10,000) or imprisoned not more than five (5) years, or both (Arkansas Statutes 20-18-105).

VR-7 (R 8/11)

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Step # 1 for filling out ar birth

2. Right after performing the previous section, go to the next part and enter the necessary particulars in all these blank fields - What is your reason for requesting, Is the person whose certificate is, Yes, Signature and telephone number of, All requests for certificates, Telephone Toll free All, Walkin You may order a certified, HOW MANY st copy costs Each, AMOUNT OF MONEY ENCLOSED , and Please PRINT the name and address.

ar birth completion process clarified (portion 2)

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