Location: Wake County Justice Center
300 S. Salisbury Street
Suite 1700
Raleigh, NC 27601
APPLICATION FOR WAKE COUNTY
BIRTH, DEATH & MARRIAGE CERTIFICATE(S)
Signature of Person Applying for Certificate
Register of Deeds
Tammy L. Brunner
Mail: Wake County Register of Deeds
Attention: Vital Records
P. O. Box 1897
Raleigh, NC 27602-1897
I hereby certify that all the above information is true to the best of my knowledge.
NOTE: IT IS A FELONY VIOLATION OF NORTH CAROLINA LAW (N.C.G.S. § 130A-26A) TO MAKE A FALSE STATEMENT ON THIS
APPLICATION OR TO UNLAWFULLY OBTAIN A CERTIFIED COPY OF A VITAL RECORD.
(Area Code) Telephone Number
Authorized agent, attorney, or legal representative of the person whose
certificate is requested. Proof Required - (N.C.G.S. § 130A 93-99)
Street Address or P.O. Box City State Zip
Middle Name
First Name
(NOTE: All adoptions are at the NC Vital Records Department in Raleigh, NC. For more information about births not occurring in Wake County,
call the NC Vital Records Department at 919-733-3000, or visit their website at http://vitalrecords.nc.gov/vitalrecords/.)
Births, Deaths & Marriages that occurred in Wake County Only
Certified Birth, Death and Marriage Certificates cost
$10 each. A photocopy of a government-issued photo ID (e.g., driver's license or passport) is required.
(Parents: If requesting birth certificate for a child under 18, please enclose photocopy of PARENT'S government-issued ID.)
The Required Information Section must be completed for all certificates requested.
First Name Middle Name
Last Name
_____ | _____ | _______
Month Day Year
Last Name (before any marriage, if different)
Name at Birth:
Date of Birth:
Full Name of Parent:
(Father / Parent 1)
Full Name of Parent:
(Mother / Parent 2)
Last Name (before any marriage, if different)
Birth Certificate
Required Information
Death Certificate
(NOTE: For more information about deaths not occurring in Wake County, call the NC Vital Records Department at 919-733-3000, or visit their website
at http://vitalrecords.nc.gov/vitalrecords/.)
Sex:
Male Female
***** Make check or money order payable to Wake County Register of Deeds. Do not send cash in the mail. Mail-in requests will be processed within
one business day of receipt. If you have questions, please call Wake County Register of Deeds, 919-856-5460, or visit http://www.wakegov.com/rod. *****
Online Vital Record Request:
https://wakerod.permitium.com
Marriage Certificate
Middle Name
First Name
Last Name
Name of Applicant 1:
(as it appears on the marriage license)
Name of Applicant 2:
(as it appears on the marriage license)
Last Name
First Name Middle Name
_____ | _____ | _______
Month Day Year
Date of Marriage:
Birth Certificates -
How Many?
Your Relationship to the Person whose Birth, Death or Marriage Certificate is requested:
Other: Specify
x $10 ea. =
x $10 ea. =
Total Amount Enclosed =
Death Certificates -
How Many?
Parent/Stepparent
Grandchild
Grandparent
x $10 ea. =
Marriage Certificates -
How Many?
Include name of town
First Name Middle Name
Last Name
_____ | _____ | _______
Month Day Year
Male Female
Sex:
WCROD-VRFORM-EN (Revised 12/2020)
First Name Middle Name
ChildSister BrotherSpouse (current)
Self (for own birth or marriage certificate)
Type and Quantity of Certificate(s)
Requested
Location of Death:
Date of Death:
Name at Death:
_____ | _____ | _______
Month Day Year
Date:
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