Order Birth Certificates

Certificate Information

First Name

Middle Name

Last Name

Date of Birth

Mother's First Name

Mother's Middle Name

Mother's Maiden Name

Father's First Name

Father's Middle Name

Father's Last Name

Birth Location

Quantity (Certificates cost $20.00 each)

Quantity

Delivery Preferences

Delivery Method

Mailing Information (The certificate will be mailed here upon payment)

Address To

Street Address

Address Line 2

City

State

Zip Code

Notes or Comments Regarding Your Order

Message

Notice

Picking Up An Order?

If you complete this order form and request to pick up your certificate(s) instead of having them shipped, you can retrieve them at the Lewis County Public Health office here:

360 NW North Street
Chehalis WA 98532

If you are having any trouble with this order form, please contact us at:
(360) 740-1223

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