Chelan-Douglas Health District200 Valley Mall Parkway
East Wenatchee, WA 98802
509-886-6400 – FAX 509-886-6478
Chelan-Douglas Health District
200 Valley Mall Parkway
East Wenatchee, WA 98802
509-886-6400 – FAX 509-886-6478
BIRTH CERTIFICATE APPLICATION
For births in the State of Washington through 1924
A certified copy of Washington state birth certificates may be obtained at the Chelan-Douglas
Health District office, 200 Valley Mall Parkway, East Wenatchee, Washington, 98802. Requests
are processed daily. Your application must be submitted by close of business to be available for
pick-up or mailing after 12:00 p.m. the next business day. The statutory fee is $20.00 per certificate.
An additional $10 fee will be required for express processing. Certified copies of births which
occurred prior to 1924 may be obtained through the Center for Health Statistics, P.O. Box 9709,
Olympia, WA 98507-9709, or by phone 360-236-4300.
**********************************************************************************
_____ Birth Certificate(s) @ $20.00 each $2.00 postage/handling fee Total: $__________
Name on record ____________________/_______________/____________________________
First Middle Last
Date of Birth _____/_____/_________ Place of Birth _______________/___________________
Month Day Year City County
Facility of Birth (Home, Hospital, etc.) _______________________________________________
Full Name of Father __________________ /_____________________/____________________
First Middle Last
Full Maiden Name of Mother __________________ /________________ /_________________
First Middle Last
Day Time Phone # ___(_____)______-_____________
Will Pick-up - (Allow 2 - 3 weeks after the birth of baby).
Please Mail - Enclose a self-addressed stamped envelope or add a $2.00 postage/handling fee.
mail to:
Name _________________________________________________________
Address _________________________________________________________
City, State, Zip _________________________________________________________
FO-02:R107/07