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Includes sections for the requester’s relationship/authority, required identification document submissions per Vermont statute, order copy counts with payment details, verification statements, and official-use fee and ID validation fields.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/application-for-certified-copy-of-vermont-birth-or-death-certificate-form-template/283476/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/application-for-certified-copy-of-vermont-birth-or-death-certificate-form-template/283476.png","ImageObject",442,249,{"name":42,"@type":43},"Aria","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What information is required to request a certified birth or death certificate in Vermont?","Question",{"text":63,"@type":64},"The form requires applicant identification and contact details, the type of certificate requested, relevant dates and towns, and key name and (for death certificates) sex information. Required fields are marked with an asterisk.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What documents must be submitted with the application?",{"text":68,"@type":64},"A copy of a valid identification document must be provided according to the Vermont statute. If the applicant does not have the listed ID types, two alternative documents showing the current address and signature are required.",{"name":70,"@type":61,"acceptedAnswer":71},"How are authorized requesters identified on the form?",{"text":72,"@type":64},"The form requires the requester to select a relationship/authority category (such as self, parent, spouse, legal guardian, or other DC/B C only options) that matches the situation and provides the correct basis for authorization.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},283476,1790033260,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":22},2336464648322,"https://ap-avatar.wpscdn.com/avatar/2200025388227c56fec?_k=1778556882303663488","Insert Logo Here  \nApplication for Certified Copy of Vermont Birth or Death Certificate  \n\n| Items with an Asterisk (*) are REQUIRED information.\u003Cbr>\u003Cbr>Applicant's Information*:\u003Cbr>Your Name: First*:   Middle:  Last*:   Suffix:   Business Name:   Mailing Address*:   City*:   State*:   Zip Code*:   Date of Birth*:  / / \u003Cbr>Phone Number *: ( ) -  Email Address:  \u003Cbr>\u003Cbr>Certificate Information*:\u003Cbr>I am requesting a (choose one)*:\u003Cbr>Birth Certificate Date of Birth*:  / /  Town of Birth*   Is this a Certificate of Birth for a Foreign-Born Child?\u003Cbr>  Yes   No\u003Cbr>Death Certificate\u003Cbr>Date of Death* : / /  Town of Death * \u003Cbr>Name on Certificate: First* :  Middle:   Last*:   Suffix:   Sex*:   Male   Female\u003Cbr>Name of Mother/Parent: First:   Middle:   Last:   Suffix:  \u003Cbr>Name of Father/Parent: First:   Middle:   Last:   Suffix:  \u003Cbr>\u003Cbr>Your Relationship to the Person Named on the Certificate (choose one)*: |\n| --- |\n| \u003Cbr>Self (BC Only) Authorized By Court Order\u003Cbr>\u003Cbr>Spouse Pursuant to 18 V.S.A. § 5016(b)(2)(B) .\u003Cbr>Child Must provide a certified copy of court order.\u003Cbr>Parent   Photo copies will not be accepted.\u003Cbr>Sibling   Authority for Final Disposition (DC Only)\u003Cbr>Grandchild   Social Security Administration (DC Only)\u003Cbr>Grandparent   U.S. Department of Veterans Affairs (DC Only)\u003Cbr>Legal Guardian   Deceased's Insurance Carrier (DC Only)\u003Cbr>Court Appointed Executor or Administrator   Employee of a Vermont public agency authorized\u003Cbr>Petitioner for Decedent's Estate (DC Only) pursuant to 18 V.S.A. § 5016(a)(6) .\u003Cbr>Legal Representative (for one of the above) |\n| Application continues on page 2. |\n\nJuly 2021 page 1 of 2  \n\n| Order Details*: |  |  |  |\n| --- | --- | --- | --- |\n| Total number of copies requested:   x $10.00 each = Order Total: $   Make checks or money orders (U.S. funds) payable to: |  |  |  |\n| Applicant's Identification Document(s)* |  |  |  |\n| As per Vermont Statute, a copy of your valid ID MUST be submitted with your application. Submit a copy of one of the documents listed below. Fill in the ID number and expiration date of the selected ID you are providing.\u003Cbr>Document \\#:   Expiration Date:  / /  |  |  |  |\n| \u003Cbr>U.S. issued Driver’s License or ID Card\u003Cbr>U.S. Territories Driver’s License or ID Card\u003Cbr>Tribal ID Card containing your signature\u003Cbr>U.S. Military ID Card containing your signature Passport: U.S. or Foreign issued\u003Cbr>VISA: U.S. issued and included within a Passport |  | | U.S. Resident Alien Card or U.S. Green Card or\u003Cbr>U.S. Permanent Resident Card (Form I-551)\u003Cbr>U.S. Employment Authorization Document or Card |\n|  |  | \u003Cbr>(Form I-765)\u003Cbr>Valid State of Vermont Employee ID\"Affidavit of Homeless Status\" form **\u003Cbr>Documentation from Vermont Department of |  |\n| containing your signature\u003Cbr>** -Does not require document number or expiration date |  |  |  |\n|  |  | Corrections substantiating identity ** |  |\n| If you do not have one of the above ID's, you must submit copies of two documents from the list below.\u003Cbr>These two documents together must show your current address and your signature.\u003Cbr>Only the documents listed below are acceptable forms of alternative ID. |  |  |  |\n| | Employee Photo ID Card with a Pay Stub or | \u003Cbr>Car Registration or Title with current address U.S. Selective Service Card\u003Cbr>Voter's Registration Card\u003Cbr>Filed Federal Tax Form with current address |  |\n| | U.S. Internal Revenue W-2 Form\u003Cbr>School, University or College Photo ID with Report Card or other proof of current enrollment Federal or State Corrections or Prisons issued ID Social Security or Medicare Card with your signature\u003Cbr>Pilot's license |  |  |\n|  |  | and signature |  |\n|  |  | | Bank Statement, Property or Utility Bill with |\n|  |  | current address |  |\n|  |  | | U.S. or State Court documents with current address |\n| Verification*: |  |  |  |\n| Any person who knowingly makes a false statement, misrepresentation or certification as to any material fact on this application shall be fined not more ","cbCaiv9zZynSIGoC","https://ap.wps.com/l/cbCaiv9zZynSIGoC","pdf",1781850,"English","# Applicant's Information\n## Certificate Information\n# Your Relationship to the Person Named on the Certificate\n## Order Details & Payment\n# Applicant's Identification Document(s)\n## Verification & Signature\n# Mail and Office Use Only","[{\"question\":\"What information is required to request a certified birth or death certificate in Vermont?\",\"answer\":\"The form requires applicant identification and contact details, the type of certificate requested, relevant dates and towns, and key name and (for death certificates) sex information. Required fields are marked with an asterisk.\"},{\"question\":\"What documents must be submitted with the application?\",\"answer\":\"A copy of a valid identification document must be provided according to the Vermont statute. If the applicant does not have the listed ID types, two alternative documents showing the current address and signature are required.\"},{\"question\":\"How are authorized requesters identified on the form?\",\"answer\":\"The form requires the requester to select a relationship/authority category (such as self, parent, spouse, legal guardian, or other DC/B C only options) that matches the situation and provides the correct basis for authorization.\"}]","Application for Certified Copy of Vermont Birth or Death Certificate - Form Template | PDF",1789609058]