A certificate of live birth for each birth occurring in Missouri must be filed within five (5) days after the date of birth (Section 193.085, RSMo).  Certificates containing erasures, whiteouts, writeovers, or faxes or reproduced copies will NOT be accepted. If your child has reached his/her twelfth birthday and no record was registered, pursuant to Section 193.105.1, RSMo, you will need to use the Delayed Birth process and will need to contact this office for further instructions at 573-751-6378. 

The certificate shall be prepared and registered by one of the following in the indicated order:

  1. The physician in attendance at or immediately after the birth.
  2. Any other person in attendance at or immediately after the birth. (Certified Nurse Midwife, Certified Professional Midwife, Certified Midwife, or Other Midwife.)
  3. The father, the mother, or, in the absence of the father and the inability of the mother, the person in charge of the premises where the birth occurred.

The certificate must be either typed or printed in permanent black ink.

Do not leave any items blank.  Indicate unknown for items when information is not known.

Mail completed form to:  Bureau of Vital Records, 930 Wildwood Drive, Jefferson City, MO 65109

To request a certificate of live birth or additional copies and further details about correctly documenting an out of facility birth/home birth, please contact the Bureau of Vital Records at 573-751-6378.

Completing Data Items

Item 1.  Child’s name: First, Middle, Last, Suffix
Item 2.  Date of birth: Enter month, day and year child was born.  (Example: You can enter the date in the MM/DD/YYYY format or write the entire date out.)
Item 3.  Time of birth: Enter exact time of birth and indicate a.m., p.m. or (m) for military
Item 4.  Sex: Spell out sex—male or female.
Item 5.  City, town, or location of birth:  Enter the name of the city, town, village or location where the birth occurred.  For births occurring on a moving conveyance, enter the city, town, village, or location where the child was first removed from the conveyance.
Item 6.  County of Birth: Enter the name of the county where the birth occurred.  For births occurring on a moving conveyance, enter the county where the child was first removed from the conveyance.
Item 7.  Place of Birth: Check the appropriate box.  If the birth occurred in an unlicensed facility, check the “other” box and list name of facility.
Item 8.  Facility Name: If the birth occurred in a licensed facility, give the name of the facility.  If the birth was not in a licensed facility, enter the house or business number and the street name of the place where the birth occurred.
Item 9a.  Mother’s Current Legal Name:

Item 9b.  Date of Birth:
Enter mother’s legal name at the time of the birth.  (first, middle, last)

Enter mother’s date of birth.  (Example: You can enter the date in the MM/DD/YYYY format or write the entire date out.)
Item 9c.  Mother’s Name Prior to First Marriage: Enter mother’s name prior to first marriage. (first, middle, last)  Do not leave this item blank.  Do not line through, state “n/a” (for not applicable), or enter the word “same”.
Item 9d.  Birthplace: Enter mother’s birthplace. (Enter the country and state of her birth.)

Residence Information

Items 10a-11d.  Mother’s Address: Enter mother’s physical address where she was residing at the time the birth occurred on lines 10 a-f.  PO Box numbers are not acceptable for items 10a-e.  If the mailing address is the same, check the box “same as residence”.  Enter current mailing address on lines 11a-d if it is different than the physical address.
Items 12a-c.  Father’s Information: Father’s information may only be added to the birth certificate if the parents are legally married, unless the mother and the person to be named as father have completed an Acknowledgment of Paternity forms to submit with the birth certificate, or a determination of paternity has been made by the court.  If the father is not named on the certificate, no other information about the father is to be completed on the certificate.
Items 13a-c.  Certifier: The certifier may not necessarily be the person who attended the delivery, but may certify to the facts of the birth.  The certifier is usually the attendant, staff from a birthing center, or one of the parents.  The certifier should sign, date, print name, and mark appropriate box.  If the “other” box is marked, state relationship to the child— i.e. father, grandmother, friend, etc.
Item 14.  Attendant name and title: When the certifier was not the attendant, type or print the full name of the person in attendance and check the appropriate box to identify the title.
Items 15a-b.  Attendant’s MO License Number and Attendant’s NPI Number For licensed medical professionals - Enter personal state medical or nursing license number of the attendant.  If the individual possesses no license at all, enter “None”.
Item 16.  Registrar’s Signature/Date Filed Leave this field blank.

Affirmation of Birth (Located at bottom of first page)

Must be signed by two other individuals not on the face of the certificate in the presence of a notary public. Attendant may sign if he/she is not the certifier. If the certifier on the certificate is a licensed physician (MD, DO) or accredited midwife (CNM, CPM, CM), the mother/father/parents listed on the certificate may sign the affirmation of birth. The witnesses may not have been present at the birth, but must be aware of the facts of the birth.

Please do NOT scratch out, strikethrough, or replace any words or phrases on the certificate such as “do solemnly declare and affirm” or “pains and penalties of perjury”, among others. If the certificate is defaced in any way, it will not be accepted.

Line 17.  Permission to provide Social Security Number: Check box.  For births filed after the child’s first birthday, parents should contact Social Security for information on how to obtain a social security number.
Line 18a-c.  Marital Information: Please note:  The “yes” box on line 18a refers to a marriage that is legally recognized by the State of Missouri.
Line 19-61.  Health, Education, Medical Information: Complete all information.  Do not leave items blank.

Evidence of Birth

Please provide the following evidence to support the facts of birth and submit with the Certificate of Live Birth.  Suggested documents include, but are not limited to:

  1. Evidence of the pregnancy
    • Prenatal or postnatal record consistent with the date of delivery
    • Physician statement
    • Hospital, clinic, or laboratory record
    • A notarized, sworn statement from two different, unrelated individuals that the mother was
    • pregnant during the time of birth to which is being sworn.
  2. Evidence of the mother’s residence in this state at the time of the birth
    Evidence documents must include mother’s name and address and be from month of birth.
    • Prenatal or postnatal record consistent with the date of delivery
    • Physician statement
    • Hospital, clinic, or laboratory record
    • Public health office statement
    • Statement from medical provider
    • Utility or telephone bill  
    • Rent receipt
    • Pay stub
    • Bank statement
    • Social service record if receiving public assistance (i.e. WIC, food stamps, child support, etc.)

Out of State Residents

If the mother resides out of state, proof of presence in Missouri during delivery in lieu of proof of residency during delivery is required. Evidence from the day of delivery include, but are not limited to:

  • Gas receipt
  • Purchase/sales receipt
  • Notarized driver/transportation statement
  • Travel documents/itineraries

Evidence of Birth Exceptions

Licensed Physician (MD, DO)
All out of facility births require a notarization of the certificate of live birth to properly document the birth. However, a licensed physician is not required to submit proof of pregnancy and residency with the notarized certificate of live birth. Proof of current and valid licensure is required.
Accredited Midwife (CNM, CPM, CM)
All out of facility births require a notarization of the certificate of live birth to properly document the birth. However, a Certified Nurse Midwife (CNM), Certified Professional Midwife (CPM), or Certified Midwife (CM) is not required to submit proof of pregnancy and residency with the notarized certificate of live birth. A lay midwife would not qualify for this exception. Proof of current and valid licensure is required.

If at any time in this process, the State Registrar has cause to question the validity or adequacy of the applicant’s statement or the documentary evidence, and if the deficiencies are not corrected, the State Registrar shall not register the report of live birth.  If the State Registrar does not register the delayed certificate of live birth, you may appeal the Bureau’s decision to a court of competent jurisdiction and obtain a court order to create a birth certificate for the child.