180 S. Main St., Ste. 252, Martinsville, IN 46151

765-342-6621, Fax: 765-342-1062 morgancohd@morgancountyhealth.com

Birth Certificate Application-Online

Online: Credit or debit card via the GovPay website:

GovPay Button

***Please note: When paying online, you MUST include a copy of the receipt from GovPay with your application forms.

For Office Use Only (Begin at #1):

Morgan County Health Department

180 S. Main St., Ste. 252

Martinsville, IN 46151

´╗┐WARNING: False applications, altering, mutilating or counterfeiting Indiana birth certificates is a criminal offense under IC 16-1-19-6.

For Certificate:


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´╗┐For Applicant:

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By checking the box below, I hereby certify that I am the requestor named above and that I am authorized to request a certified copy of the record for the above named individual, in accordance with Indiana Code 16-37 and 410 Indiana Administrative Code 18. I understand that penalties are described by law for misrepresentation on this request.

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A Birth Certificate set costs $15.00 each (online). This includes one full size and one wallet-size certificate. You may purchase vinyl covers in full size and/or wallet-size for $2.00 each. Please indicate your choices and quantities below.

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*** I.D. required. Please provide 1 form of identification. ***

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If you would like the certificate mailed somewhere other than the above address, please print name and address of the person to whom the certificate is to be mailed: