Date:

To: Whom It May Concern:

Please forward to my attention a certified birth certificate for:

Exact Name:
Date of Birth:
Town or City of Birth:
Sex:

I am the individual for whose record is being requested.

Enclosed is my credit card information for your use to pay for my request:

Credit Card Number:
Expiration Date:
Exact Name on Card:

If you require a check instead, please send me the amount due in the enclosed stamped self-addressed envelope and I will send it to you by return mail.

Thank you for your assistance in this matter,

Best regards,

_____________
Signer

Birth Certificate, Request for
Review List

This review list is provided to inform you about this document in question and assist you in its preparation. If you are a Trustee or Executor making this request, simply rewrite the language to reflect that fact and include a copy of your official authorization to act in that capacity. Keep a copy of the transaction so you can send in a second notice. We recommend you make a phone call, if possible, to the proper location first to find out whether you need to have a bank check instead of a credit card, the correct amount of the total charge, and the proper department to send it to. On the other hand, if you have time and are not in a hurry, it can be less frustrating and just as effective in the long term, to send out an initial letter and let the bureaucracy grind slowly and respond at its pace.

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