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2. Yakima Health District
   
3. Birth and Death Certificate Application/Solicitud Para Acta de Nacimiento y Difuncion
5. Form Instructions
   Incomplete applications will not be processed. We will not process applications that we have not received payment for or are missing information. Processing time can take between 48-72hrs.
7. Payment Information
   Applications will not be processed until payment is made. We will contact you at the number your provide on this application for payment as soon as we receive your application.
8. How are you paying for your record?

   1. Over the Phone Payment (takes 48-72hrs to process)
   2. Online-Available through VitalChek Only (*additional fees apply for online convenience)
10. 
11. Additional Fees Apply: $6.00 for VitalChek Processing + $8.00 search fee for non-matching record requests.
    Click Here for VitalChek Online Payment Option
13. What Certificate type are you requesting today?*

    1. Birth Certificate(s)
    2. Death Certificate(s)
15. How Many Copies of the Birth/Death Certificate are you requesting?*
16. How Would You Like to Receive your Birth/Death Certificate(s)?*
    -- Select One --$22 Regular Mail 7-10 Business Days$27 Priority Mail 5-10 Business Days$20 Next Day Pick-Up-Don't mail$30 Same Day Pick-Up-Don't mail
18. Name on Birth/Death Certificate include (First, Middle, Last) Nombre en la Acta de Nacimiento/Difuncion (Primero, Segundó, Apellido(s))*
20. Date of Birth/Fecha de Nacimiento
    Date of Birth/Fecha de Nacimiento
21. Place of Birth/Lugar de Nacimiento (Hospital and/or City/Ciudad)
23. Maiden Full Name of Mother/ Nombre Completo de la Madre*
25. Full Name of Father/Nombre Completo del Padre*
27. If Requesting a Death Certificate Provide the Date and Place of Death
29. Date of Death/Fecha de Difuncion
    Date of Death/Fecha de Difuncion
30. Place of Death/Lugar de Fallecimiento
32. Person picking up or ordering certificate must complete the following for identification purposes:/La persona que recoja o solicite un certificado debe completar lo siguiente para propositos de identificación
34. Requestor Name (First, Middle, Last) Nombre de la recoja (Primero, Segundó, Apellido(s))
36. Address/Domicilio Residencial
38. City/Ciudad
39. State/Estado
40. Zip Code/Código
42. Phone Number/Numero de Telefono
44. Email Address
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

* indicates a required field