Durham County Register of Deeds Vital Records Requests

This is an official request for an aspect of the Durham County Register of Deeds Vital Record. The information contained in this request should be considered private. Please complete all information in full and then finalize the order process through payment of the 'order fee'.

A person who willfully and knowingly makes any false statement in an application for a certified copy of a vital record, or who willfully and knowingly supplies false information intending that the information be used in the obtaining of any copy of a vital record will be guilty of a class I felony (NCGS 130A-26A)

PICK UP INSTRUCTIONS: Please indicate in the Special Notes whether you would like to schedule a pick up for your documents.

You will be notified by email when your document is ready for pick-up. If there is no pick up reference indicated, documents will automatically be mailed to the address on the request.

The fee payment will be paid through Permitium Payments. The charge will show on your credit card statement as 'PermVitalRecs'. This is a secure and trusted provider of payment services.

Please Enter The Full Name On The Birth Certificate:

Last Name: ^{(full name, no initials)}

First Name:

Middle Name:

Suffix:

Information Related To Birth:

Date of Birth:

Confirm Birth Year:

Birth City:

Birth County:

Durham County

Birth State:

Parent Names As Listed on Birth Certificate:

Mother/Parent's Last Name:

Mother/Parent's First Name:

Mother/Parent's Middle Name:

Mother/Parent's Maiden Name:

Mother/Parent's Birth State:

Mother/Parent's Birth Country:

Father/Parent's Last Name:

Father/Parent's First Name:

Father/Parent's Middle Name:

Father/Parent's Birth State:

Father/Parent's Birth Country:

Please Enter The Requestor's Name:

Last Name: ^{(full name, no initials)}

First Name:

Middle Name:

Maiden Name:

Suffix:

Last 4 SSN:

Last 4 SSN: ^(confirm)

Requestor Date of Birth:

Requestor Current Age:

Requestor's Current Residence Address: ^{(this may be different than the mailing address)}

Address Line 1:

Address Line 2:

City:

State: ^(region)

Zip Code: ^{(postal code)}

Country:

^{Mailing Address Different:}

Yes No

Requestor's Current Mailing Address: ^{(if different from residence address)}

Address Line 1:

Address Line 2:

City:

State: ^(region)

Zip Code: ^{(postal code)}

Country:

Requestor's Contact Telephone Numbers: ^{(###-###-####)}

^Home:

^Work:

^{Cell Phone:}

^Fax:

Updates via Text Message?

Yes No

Requestor's Driver's License: ^{(or other State Issued ID)}

^{ID Number:}

^{Issuing State:}

Requestor's Email:

^Address:

^Confirm:

Please attach your photo identification

I will mail or fax these documents. We can only accept valid state issued ID.

"SELFIES" ARE NOT VALID FORMS OF IDENTIFICATION AND WILL NOT BE ACCEPTED.

The acceptable forms of identification are:

State Issued Driver’s License – NOT EXPIRED
State Issued Identification Card - NOT EXPIRED
Passport - NOT EXPIRED
Military Identification

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Special Instructions :

Select Delivery Method:

Please select the document delivery method

I will PICK-UP these documents at:

Durham County Register of Deeds

201 East Main Street – 2nd Floor

Administration Building II

Durham, North Carolina 27701

You will be notified by email when your document is ready for pick-up

I would like my document(s) delivered via MAIL.

The individual listed on the Birth Certificate is:

Myself
My Spouse
My Brother / Sister
My Child / Step-child
My Parent / Step-Parent
My Grandparent / Grandchild
Authorized Agent, Attorney
Legal Representative (proof required)

Select The Information Type(s) Requested:

Total Fee:

$0

AUTHORIZATION NOTIFICATION:

My initials below constitute an electronic signature and authorizes the Durham County Register of Deeds Department of Vital Records to release information and / or my vital record and confirms I have completed all sections accurately and truthfully, including information verifying my identity. I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other party or agency without my expressed written consent except under authority of North Carolina General Statutes 130A-26A, and 130A-93.

I have enclosed the correct fees and understand that they are nonrefundable. I understand that an incomplete form will not be processed and will be considered closed after expiration of the 30 day notification window. I declare under penalty of perjury that the foregoing is true and correct.

Coupon Code:

Requestor's Initials:

Clear Form

Online Birth Certificate Request

Please Enter The Full Name On The Birth Certificate:

Information Related To Birth:

Parent Names As Listed on Birth Certificate:

Please Enter The Requestor's Name:

Requestor's Current Residence Address: ^{(this may be different than the mailing address)}

Requestor's Current Mailing Address: ^{(if different from residence address)}

Requestor's Contact Telephone Numbers: ^{(###-###-####)}

Requestor's Driver's License: ^{(or other State Issued ID)}

Requestor's Email:

Please attach your photo identification

Select Delivery Method:

Documents Will Be Delivered To: ^{please enter the delivery addresses}

The individual listed on the Birth Certificate is:

Select The Information Type(s) Requested:

Total Fee:

$0

Online Birth Certificate Request

Add An Address

A Shipping Address Is Required!

Please Enter The Full Name On The Birth Certificate:

Information Related To Birth:

Parent Names As Listed on Birth Certificate:

Please Enter The Requestor's Name:

Requestor's Current Residence Address: (this may be different than the mailing address)

Requestor's Current Mailing Address: (if different from residence address)

Requestor's Contact Telephone Numbers: (###-###-####)

Requestor's Driver's License: (or other State Issued ID)

Requestor's Email:

Please attach your photo identification

Select Delivery Method:

Documents Will Be Delivered To: please enter the delivery addresses

The individual listed on the Birth Certificate is:

Select The Information Type(s) Requested:

Total Fee:

$0

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Requestor's Current Residence Address: ^{(this may be different than the mailing address)}

Requestor's Current Mailing Address: ^{(if different from residence address)}

Requestor's Contact Telephone Numbers: ^{(###-###-####)}

Requestor's Driver's License: ^{(or other State Issued ID)}

Documents Will Be Delivered To: ^{please enter the delivery addresses}