Fillable Printable Certified Birth Certification Application - City of Troy
Fillable Printable Certified Birth Certification Application - City of Troy
Certified Birth Certification Application - City of Troy
City of Troy
City Clerk’s Office
500 West Big Beaver
Troy, Michigan 48084
(248) 524-3317
(Send Application & Payment to Above Address or
Appear in Person at the City Clerk ’s Off ice Between t he
Hours of 8:00 AM and 4:30 PM.)
See reverse side f o r postage options and fe e calc ulations.
(Revised 10/3/2013)
CERTIFIED BIRTH CERTIFICATE APPLICATION
PLEASE PRINT INF ORMATIO N IN I NK (ONE APPLI CATION PER CHILD)
Chil d ’ s Ful l Name
Child’s Birth Date
Mother’s Maiden Name
Issue C op ies To:
Name
Address
City/State/Zip
Daytime Phone Number
Applica nt’s Driver’s License Number
(A COP Y OF THE DRIVER’S LICENSE M UST BE INCLUDED)
Applicant’s Relationship to Child
(MUST BE NAMED ON CERTIFICATE)
The above informati on is tr ue a nd accur at e to the best of my knowledge .
Applicant’ s Signature
Number of Copies
See reverse side for fee and shipping methods.
AC CE P TABLE METHODS O F PAYM E NT
REQUESTS BY MAIL: Please submit CHECK or MONEY ORDER payable to CI TY OF TROY .
REQU ES TS IN PER S ON :
CASH, CHECK, MONEY ORDER, OR DEB IT CARD (with PIN). The
City of Troy does NOT accept CREDIT CARDS .
PLEASE ENCLOSE A COPY OF THE APP LICANT’S DRIVER’S LICENSE.
Clerk’s Office Use Onl y
Form of Payment
Check Number
Date Copies Issued
Amount Enclosed
Local File Number
Employee Initials
Please check the number of copies requested
and the shipping method you desire:
Numbe r of Copies
Fee Owed
1 $ 15.00
2
$ 20.00
3 $ 25.00
4
$ 30.00
5
$ 35.00
6 $ 40.00
7
$ 45.00
8 $ 50.00
9
$ 55.00
10
$ 60.00
First Cl ass Mail No Charge
Certi fied Mail/Return Receipt Add $ 7.00
Ove rnight Mail Add $ 19.99
Your Total:
Payment Options
BY MAIL: Please submit CHECK or MONEY ORDER payable to CITY OF TROY.
IN PERSON:
CASH, CHECK, MONEY ORDER, OR DEBIT CARD (with PIN). The City of
Troy does NOT accept CREDIT CARDS.
Shipping Options
First C l ass Mail : This shipping opti on is free of c harge and should arrive in seven (7) to ten
(10) busines s da y s.
Certifi ed M ail /
Return Receipt:
This service offers delivery security in the way of
an article tracking
number. Also, the recipient's signature is obtained on a card at the time of
delivery, and the card is returned to the City Clerk's Office. Articles are sent
First Class Mail and should arrive in (7) to (10) business days. The fee for
this service is $7.00. This option is available for orders within the
continenta l U.S. only.
Overnight M ail:
This service guarantees delivery the next business day after mailing. A
tracking number is available to track the article online. The fee for this
service is $19.00. Please al low 1-2 busi n ess days to pr ocess y our requ est.
