Michigan Application Birth Form – Fill Out and Use This PDF

REQUIRED DOCUMENTATION

Changes or corrections to birth records that can be made by this office are limited by law and are subject to very specific supporting documentation. In general, you must include with this application, at least two (2) pieces of dated documentary evidence. To change any part of the name requires two documents dated close to the time of birth. (Exception: Only one document dated five years ago is required to correct the spelling of the first or middle name of the person named on the record). If you are requesting that the name on the record be changed due to a legal name change, only the court order is needed for documentation. If you need more information or have questions, you may call our Changes Unit direct at 517-335-8660.

PAYMENT - The fee for correcting or changing a Michigan birth record is $50.00 and includes one copy of the record with the changes made. Additional copies of the new record are available for $16.00 each when ordered at the same time. Payment must be by check or money order and made payable to the "State of Michigan."

PROCESSING TIME – Normal processing time for all changes or corrections will be 5-6 weeks from the date all documentation, payments and photo ID are received in the State Vital Records Office. Two-three week rush processing is available for an additional fee.

Application Fee	$50.00	$ 50.00
(Non-Refundable)
Fee includes one (1) certified copy of
the record
________ Additional Certified Copies	$16.00 Each	$
Rush Fee	$25.00	$
TOTAL ENCLOSED		$

PENALTIES: Any person who willfully and knowingly makes false application to change a Michigan birth record may be fined and/or imprisoned pursuant to MCL 333.2894(1)(b) and (c).

For Accounting Use Only

The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or

expression, political beliefs or disability.

Note: Applications sent to the Vital Records post office box with an

overnight delivery are not received in Vital Records for three (3) days.

DCH-0847-CHGBX Rev 8-2021 MCL 333.2871(1) and 333.2891(10)

PHOTO ID REQUIREMENTS FOR CHANGING OR CORRECTING

A MICHIGAN BIRTH RECORD

*Please Send Photocopies – Not Original Documents*

Under Michigan law, birth records are restricted documents. To request a birth record, a current valid, government issued identification is required to establish eligibility (except for an unrestricted birth record that is at least 100 years old). To protect from identity theft, a copy of the applicant’s government issued identification must be presented along with the application and fees.

Tier 1 Documentation that establishes identity by itself.

U.S. or Foreign Passport

U.S. Passport Card

U.S. or U.S. Territories Driver’s License or Identification Card

U.S. Military Identification Card with both picture and signature

Other U.S. or U.S. Territories issued document that meets the following criteria: Document must be unexpired. Document must contain a photograph and at least the following information: name, date of birth, date of expiration, signature, and address.

--OR (If you do not have a document from Tier 1)

Tier 2 Documentation must include all documentation in one of the categories below:

Any of the documents in Tier 1 that expired within the past 5 years and any one document from Tier 3 issued within the past year.

Employment identification with photo, accompanied with a pay stub or W-2 form issued within the past year.

Student identification with photo, accompanied by a current report card or other proof of current school enrollment. Both documents must be for the same institution.

Department of Corrections identification card accompanied by probation or discharge papers issued within the past year.

If an inmate is currently incarcerated, a Department of Corrections identification card, accompanied by a verification of incarceration issued within the past year.

--OR (If you do not have documents from Tier 1 or 2)

Tier 3 Documentation must include at least three alternative documents of different types from the list below, one must have been issued within the past year:

Any of the documents in Tier 1 expired more than 5 years.

Social Security Card (must be signed)

Marriage or Divorce certificate

Your child’s birth certificate

IRS form W-2

Paycheck stub

Bank statement

Voter registration

Motor vehicle registration

Health insurance card

Utility Bill

Doctor/hospital/dentist bill

Religious/community organization documents, baptismal certificate

Military DD-214 discharge paper or equivalent

School records

Letter/benefit statement from a government agency, like SSA or

IRS

Land or rental agreement

Military ID with either a picture or signature.

Other documents that establish identity to a degree equivalent to those listed above.