Form VS-7 at a glance
What it is: Form VS-7 is the Application for Stillbirth Certificate of the State of Connecticut Department of Public Health Vital Records.
Who signs: The mother signs under Signature of Mother and the father signs under Signature of Father, each with a date signed.
Only the parent of the stillborn may file and obtain a copy of a stillbirth certificate for that event.
A filled-in Form VS-7 example: an unmarried mother requests one copy
How to fill out Form VS-7, box by box
Name of stillborn and gender
Print the entire name of the stillborn as it currently appears on the fetal death record.
Mark Male, Female or Undet. for the gender; gender will not be listed for Undetermined.
Date and place of stillbirth
Enter the date of stillbirth (Month/Day/Year) and the place of stillbirth, city.
Enter the name of the hospital; if delivery occurred outside of a hospital, list the street address where the delivery occurred.
Mother's full name and birth surname
Enter the mother's full name as of the date of stillbirth (First/Middle/Last) and the mother's birth surname.
Father's full name
Enter the father's full name as of the date of stillbirth; this item may be left blank if the mother was unmarried and no AOP was filed.
Requestor and applicant
Print or type the requestor name and the telephone number, including the area code; the requestor must attach a copy of picture identification.
Enter the requestor's complete mailing address, including the apartment number if applicable, and the city, state and zip code.
Copies and fee
Enter the number of copies requested.
The fee is $30.00 per copy (checked October 29, 2026); make money orders payable to: Treasurer, State of CT.
Signatures
The mother signs under Signature of Mother and the father signs under Signature of Father, each with a date signed.
More rules for Form VS-7
The parent must submit a valid government issued photo identification and payment of $30.00 (checked October 29, 2026).
Common questions about Form VS-7
Where do I file it?
Mail the request and identification to: State Registrar of Vital Records, Department of Public Health, Vital Records-MS#11VRS, 410 Capitol Avenue, Hartford, CT 06134-0308.
Sources
[1] Form VS-7, Application for Stillbirth Certificate, Connecticut Department of Public Health (the Official source link on this page).