Date_________ ID_____________ Book_________Page_________ Paid_________ CK/Cash    
                                                              Marriage License #______________________

Moore County Register of Deeds
Application for Certified Copy of a Vital Record               
Click here to print form

Please Print or Type                       *** Birth Certificate ***

Name at Birth: ________________________________________________________________

Date of Birth: _________________________________________________________________

Father’s Full Name: ____________________________________________________________

Mother’s Full Maiden Name: ____________________________________________________

*** Death Certificate ***

Full Name of Deceased:_________________________________________________________

Date of Death: _________________________________________________________________

Number of Copies: _____________________________________________________________

***Marriage Certificate ***

Name of Groom: _______________________________________________________________

Name of Bride: ________________________________________________________________

Date of Marriage: ______________________________________________________________

THE CERTIFICATE OF THE ABOVE NAMED PERSON IS FOR:
1. My Self
2. My Spouse
3. My Brother
4. My Sister
5. My Child
6. My Parent
7. I am seeking information for legal determination of personal or property rights.
8. I am authorized agent, attorney or legal representative of the person listed above. (Proof required).
9. Other __________________________________________________________________
  I hereby certify that all of the above Information given is true to the best of my                
  knowledge and belief.

  ______________________________________
   Signature of Applicant

  ______________________________________
   Mailing Address

  ______________________________________
   City State and Zip Code