Birth Certificate Fee Worksheet

Print this page and mail or fax it with your completed application(s).

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Print your name as it appears on your application:
How many Item Fee for each Total
per certificate for each registrant
$16
$
Optional - An Expedite fee is a per-record fee that will place your request ahead of other requests. An Expedite fee does NOT include Federal Express or other special mailing fees.
$20
$
Optional - Federal Express Mail Service is $16 for most deliveries. Higher rates apply to Saturday or international service and to deliveries to Alaska and Hawaii.
$16
(per order only)
$
Mandatory fee for credit card transactions
$6
$
Total amount included:
$
Credit card users:
Card number:
Expiration date:

Make your check or money order payable to the Minnesota Department of Health. Checks returned for nonpayment will be charged a $30 fee according to Minnesota Statutes, section 604.113, subdivision 2, and civil penalties may be imposed for nonpayment.

Mail the completed application form, birth certificate fee worksheet, copy of your valid drivers license or state issued ID and payment to:
Minnesota Department of Health
Attention: Office of the State Registrar
P.O. Box 64882
St. Paul, Minnesota 55164-0882

OR

Fax the completed form, birth certificate fee worksheet, credit card (Master Card, VISA, and Discover Card) number and expiration date to 651-201-5740.

If you have questions, please e-mail osr1@health.state.mn.us or call 651-201-5970.

Updated 12.4.2009 Tuesday, 16-Nov-2010 12:20:16 CST