The VS 6 Virginia form is an official application used to request certification of vital records in Virginia, such as birth, death, marriage, and divorce certificates. This form is essential for individuals seeking to obtain legal proof of these important life events, as it outlines the necessary information and fees required for processing. Understanding how to properly fill out this form can streamline the application process and ensure that you receive the documents you need efficiently.
The VS 6 Virginia form serves as a crucial tool for individuals seeking to obtain certified copies of vital records, such as birth, death, marriage, and divorce certificates. This application is governed by Virginia statutes, which stipulate a fee of $12.00 for each certification or for a search of the records when no certification is issued. Requesters must provide personal information, including their name, contact details, and relationship to the individual named on the certificate. Additionally, the form requires the requester to specify the purpose for obtaining the certificate. Importantly, applicants must submit a valid form of identification, which can be a photo ID from a recognized authority or a combination of secondary documents. The VS 6 form also highlights the legal implications of submitting false information, as it constitutes a felony under state and federal law. Furthermore, the form outlines the necessary details for each type of record requested, ensuring that the information is complete and accurate. Understanding the requirements and implications of this form is essential for anyone navigating the process of obtaining vital records in Virginia.
VS6-2/06
COMMONWEALTH OF VIRGINIA
Application for Certification of a Vital Record
Virginia statutes require a fee of $12.00 be charged for each certification of a vital record or for a search of the files when no certification is made. Please make check or money order payable to State Health Department. There is a $50.00 service charge for returned checks.
Name of Requester: ________________________________________________ Daytime Phone Number (______)___________________________
(person requesting the certificate)
Address: ________________________________________________ City: ___________________________ State: __________________ Zip: ___________________
What is your relationship to the person named on the certificate? (Check one)
____ Self _____ Mother ____ Father _____ Child ______ Current Spouse ____ Sister _____ Brother _____ Maternal Grandparent
_____ Paternal Grandparent ______Legal Guardian (submit custody order) _____ Other (Specify) _________________________________
What is your reason for requesting this certificate? ____________________________________________________________________
I understand that making a FALSE application for a vital record is a FELONY under state and federal law.
Signature of Requester: ___________________________________________________________________________
IMPORTANT: The person requesting the vital record must submit a copy of their identification. See list on reverse side.
BIRTH CARDS ARE NO LONGER AVAILABLE.
BIRTH
Number
Name at Birth:
of Copies
If name has changed since birth due to adoption, court order, or any reason
Paper: ____________
other than marriage, please list changed name here:
_________________________________________________________________________________
Date of Birth:
Race:
Sex:
Place of Birth:
Hospital of Birth:
(City/County in Virginia)
Full Maiden Name of Mother:
Full Name of Father: _______________________________________________________________
DEATH
STILLBIRTH
Name of Deceased: ________________________________________________________________
of Copies: ___________
Date of Death:
Age at Death:
Sex: __________
Place of Death:
Hospital Name: ______________________
Full Maiden name of Mother: _______________________________________________________
MARRIAGE
Full Name of Husband:
of Copies: ____________
Full Name of Wife:
DIVORCE
Marriage - Date:
Place:
Divorce - Date:
If Marriage, place where license was issued: _____________________________________________
Please indicate the address you wish the certificate(s) mailed to in the box below. -- Please type or print clearly.
Name
Send Completed Application To:
Address
Division of Vital Records
P. O. Box 1000
Richmond, VA 23218-1000
City/State/Zip
(804) 662-6200
www.vdh.virginia.gov
The State Registrar reserves the right (§32.1-271C) to accept or deny any application submitted.
ACCEPTABLE IDENTIFICATION
SUBMIT ONE (1) DOCUMENT FROM THE PRIMARY LIST OR TWO (2) DOCUMENTS FROM THE SECONDARY LIST.
The acceptable documents listed may change without prior notice.
PRIMARY LIST
1.Photo Drivers License issued by US DMV office - unexpired or expired for not more than one year
2.Photo Learners/Instruction Permit issue by US DMV office -unexpired or expired for not more than one year
3.Photo Identification Card issued by US DMV Office - unexpired or expired for not more than one year
4.Current Photo Identification Card - (school, employment). Check Cashing Cards are not acceptable
5.Military Card - unexpired - active duty or retired member
6.U.S. Passport – unexpired
7. Foreign Passport with Visa, I-94 or I-94W - unexpired
8.U.S. Certificate of Naturalization - (form N-550, N-570 or N-578)
9.U.S. Certificate of Citizenship - (form N-560 or N-561)
10.U.S. Citizen Identification Card - (form I-197)
11.Temporary Resident Card - unexpired - (form I-688)
12.Employment Authorization Card - unexpired - (form I-688A, I-688B)
13.Refugee Travel Document - unexpired- (form I-571)
14.Resident Alien Card – unexpired - (form I-551)
15.Permanent Resident Card - unexpired - (form I-551)
16.Northern Marianas Card - unexpired - (form I-551)
17.Asylum - A copy of the first and last page of application for Asylum
18.Birth Abroad (Consular Report) of a Citizen of the U.S.A. (form FS-240)
19.Birth Abroad (Certification of Report) of a Citizen of the U.S.A.
20.Virginia Criminal Justice Agency Offender Information Form
21.United States Probation Offender Information Form
SECONDARY LIST
22.U.S. Selective Service Card
23.U.S. Military Discharge Papers - (form DD214)
24.Certified School Records/Transcript issued by a U.S. state or territory
25.Enrollment, Certificate of - issued by VA Dept of Education
26.Life insurance policy
27.
HEALTH CARE INSURANCE CARD
28.Welfare/social services identification card with photo - unexpired – issued by municipality
29.Photo Drivers License - issued by US DMV office expired not more than 5 years
30.Photo Learners/Instruction Permit - issued by US DMV office expired not more than 5 years
31.Photo Identification card - issued by US DMV office expired not more than 5 years
32.U. S. Passport - expired not more than 5 years
33.Foreign Passport - expired not more than 5 years, with a VISA,
34.
Military dependent ID card, with photo - unexpired
35.
Weapons or gun permit issued by federal state or municipal government-unexpired
36.
Pilots License – unexpired
37.
INS form I-797 (applicable only for individuals whose names appear on the form)
38.
IAP-66 U.S. Department of State form (applicable only for the individuals whose names
appear on the form).
39.
Veterans Universal Access Identification Card
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