VoteRiders Voter ID Clinics – Training Materials STATE BIRTH CERTIFICATE TABLE Use of this form indicates that you are part of a VoteRiders Partner Organization-led Voter ID Clinic and will share the non-personal data collected from the Clinic with VoteRiders. State Can Attorney Order? Notary needed? Fee Address Alabama Yes - request as Legal $15 Alabama Center for Health Statistics http://adph.org Representative, state Alabama Department of Public Health (334) 206-5418 reason as "legal issue" P.O. BoX 5625 Include Rep Agreement Montgomery, AL 36103-5625 and atty's photo ID Alaska Yes - include letter stating $25 Department of Health and Social Services http://dhss.alaska.gov whom atty represents, Bureau of Vital Statistics (907) 465-3391 Rep Agreement and 5441 Commercial Boulevard atty's photo ID Juneau, AK 99801 Arizona Yes - letter on attorney's $20 money Office of Vital Records order/ http://www.azdhs.gov letterhead stating Arizona Department of Health Services relationship to registrant cashier's P.O. Box 3887 check and include atty ID#, PhoeniX, AZ 85030-3887 photo ID, and Rep Agreement Arkansas Yes - request as the $12 Arkansas Department of Health registrant's Designated Vital Records Section, Slot 44 http://www.healthy.arkansas.gov Representative; include 4815 West Markham Street (501) 661-2336 Rep Agreement, atty's Little Rock, AR 72205 photo ID © 2013 VoteRiders VoteRiders Voter ID Clinics – Training Materials California Yes - letter stating Notarized $18 CA Depart of Public Health - Vital Records http://www.cdph.ca.gov atty represents the reg- signature is MS: 5103 (916) 445-2684 required istrant. Include Rep P.O. BoX 997410 Agreement and atty's Sacramento, CA 95899-7410 photo ID Colorado Yes - request as Legal $17.75 Vital Records Section http://www.colorado.gov Representative CO Dept of Public Health & Environment (303) 692-2200 Include Rep Agreement 4300 Cherry Creek Drive South and atty photo ID HSVRD-VS-A1 Denver, CO 80246-1530 Connecticut Yes - request as Legal $35 Department of Public Health http://www.ct.gov Representative, include 410 Capitol Avenue, MS #11 VRS (860) 509-7897 Rep Agreement and Hartford, CT 06134 atty's photo ID Delaware Yes - request as Legal $25 Office of Vital Statistics http://www.dhss.delaware.gov Representative, include Division of Public Health (302) 744-4549 417 Federal Street Rep Agreement and Dover, DE 19901 atty's photo ID District of Columbia Yes - letter on firm letter- $23 include Vital Records Division http://doh.dc.gov head, Rep Agreement, SASE 899 North Capitol Street NE (202)671-5000 Washington, DC 20002 atty's photo ID Florida Yes - request as Legal $9 Department of Health http://www.doh.state.fl.us Representative, include Bureau of Vital Statistics (904) 359-6900 P.O. BoX 210 Rep Agreement and 1217 Pearl Street (Zip 32202) atty's photo ID Jacksonville, FL 32231-0042 Georgia Yes - request as Author- $25 Georgia Department of Public Health http://health.state.ga.us ized Legal Agent and Vital Records (404) 679-4702 2600 Skyland Drive, NE include Rep Agreement Atlanta, GA 30319-3640 and atty's photo ID © 2013 VoteRiders VoteRiders Voter ID Clinics – Training Materials Hawaii No - website states that $10 money State Department of Health order, Office of Health Status Monitoring http://hawaii.gov record mailed to atty if (808) 586-4539 registrant signs a letter cashier's Vital Records Section check or P.O. BoX 3378 authorizing its release certified check Honolulu, HI 96801-9984 and includes a copy of his or her photo ID Idaho Yes - request as Legal $13 computer Vital Records Unit http://healthandwelfare.idaho.gov Representative, include $18 Bureau of Vital Records & Health (208) 334-5988 photostatic Statistics Rep Agreement and atty photo ID P.O. BoX 83720 Boise, ID 83720-0036 Illinois Yes - request as Legal $15 Division of Vital Records Illinois Department of Public Health http://www.idph.state.il.us Representative for 925 E Ridgely Avenue (217) 782-6553 registrant and include Springfield, IL 62702 a letter from registrant permitting release to atty; include Rep Agreement and atty photo ID Indiana Yes - must represent reg- $10 Vital Records http://www.in.gov istrant and eXplain the Indiana State Department of Health (317) 233-2700 registrant's direct interest P.O. BoX 7125 Indianapolis, IN 46206-7125 in a letter written on firm letterhead; include Rep Agreement and atty's photo ID Iowa Yes - request as Legal Application $15 Iowa Department of Public Health must be http://www.idph.state.ia.us Representative and Bureau of Vital Records notarized (515) 281-4944 include Rep Agreement Lucas Office Building and atty's ID 321 East 12th Street Des Moines, IA 50319-0075 © 2013 VoteRiders VoteRiders Voter ID Clinics – Training Materials Kansas Yes - request on firm $15 Office of Vital Statistics http://www.kdheks.gov letterhead detailing Curtis State Office Building (785) 296-1400 purpose of request and 1000 SW Jackson Street, Suite 120 include copy of atty ID Topeka, Kansas 66612-2221 card Kentucky Yes - vital records are $10 Office of Vital Statistics open to the public – http://chfs.ky.gov Department for Public Health just fill out application (502) 564-4212 Cabinet for Health and Family Services and include fee 275 East Main Street 1E-A Frankfort, KY 40621 Louisiana Yes- request as Legal $15.50 long Office of Public Health $9.50 short http://new.dhh.louisiana.gov Representative and Vital Records Registry include Rep Agreement P.O. BoX 60630 and atty's photo ID New Orleans, LA 70160 Maine Yes - request as Author- $15 Maine CDC Office Vital Records http://www.maine.gov ized Legal Representative Department of Health & Human Services (207) 287-3181 include Rep Agreement 244 Water Street atty's photo ID #11 State House Station NOTE: Maine has no Augusta, ME 04333-0011 pre-printed application Maryland Yes - request as Legal Notarized $24 Division of Vital Records letter from include SASE http://dhmh.maryland.gov Representative, include Department of Health & Mental Hygiene registrant (410) 764-3038 Rep Agreement and 6550 Reisterstown Road permitting atty's photo ID P.O. BoX 68760 release to atty Baltimore, MD 21215-0036 Massachusetts Yes - request as Legal $28 by mail Registry of Vital Records and Statistics Representative on firm include SASE http://www.mass.gov 150 Mount Vernon Street letterhead, include atty’s (617) 740-2600 1st Floor photo ID and copy of atty Dorchester, MA 02125-3105 license and some form of identifying ID for client. © 2013 VoteRiders VoteRiders Voter ID Clinics – Training Materials $26 Michigan Yes - request as Legal Vital Records Request $7 Sr. Citizen P.O. BoX 30721 http://www.michigan.gov/mdch Representative of requesting Lansing, MI 48909 person on BC include (517) 335-8666 own record letter on firm letterhead identifying person represented and include atty ID # and photo ID; but must also include 3 official documents stating client’s name & DOB. Minnesota Yes - request as attorney Application $26 Minnesota Department of Health http://www.health.state.mn.us and include copy of atty must be Central Cashiering - Vital Records (651) 201-5980 license, Rep Agreement notarized and P.O. BoX 64499 and photo ID signed by atty St Paul, MN 55164 Mississippi Yes - request as Legal $15 Vital Records Representative, include State Department of Health http://www.msdh.state.ms.us Rep Agreement and atty P.O. Box 1700 (601) 576-7450 photo ID Jackson, MS 39215-1700 Missouri Yes - request as Legal Notarized $15 MO Depart of Health & Senior Services Representative and state signature is include SASE http://health.mo.gov/ Bureau of Vital Records (573) 751-6387 why you’re requesting required 930 Wildwood record. Include Rep P.O. BoX 570 Agreement and Jefferson City, MO 65102-0570 atty photo ID Montana Yes-request as Authorized $12 Office of Vital Statistics Legal Representative, MT Dept of Public Health & Human Svcs http://www.dphhs.mt.gov include Rep Agreement 111 N Sanders, Rm. 209 (406) 444-2685 and atty's photo ID P.O. BoX 4210 Helena, MT 59604 © 2013 VoteRiders VoteRiders Voter ID Clinics – Training Materials Nebraska Yes - request as Legal $12 Vital Records Representative - to be http://dhhs.ne.gov/ 1033 O Street, Suite 130 used for a legal purpose (402) 471-2835 P.O. BoX 95065 3-004.02C to obtain gov't Lincoln, NE 68509-5065 documents, include Rep Agreement and atty's photo ID Nevada Yes - request as Legal $20 Office of Vital Records http://health.nv.gov/ Representative, include 4150 Technology Way, Suite 104 Rep Agreement and atty's Carson City, NV 89706 (775) 684-4242 photo ID New Hampshire Yes - request as Legal Rep- $15 Division of Vital Records Administration resentative on firm letter- http://www.sos.nh.gov/ Archives Building (603) 271-4654 head stating reason why 71 South Fruit Street record is needed, include Concord, NH 03301-2410 copy of atty's license New Jersey Yes - request as Legal Client must sign $25 NJ Department of Health a notarized http://www.state.nj.us/health Representative, include Vital Statistics and Registry letter permitting (609) 292-4087 Rep Agreement and atty's PO BoX 370 release of photo ID Trenton, NJ 08625-0370 record to atty New MeXico Yes - request as Legal Rep- Client must sign $10 New MeXico Vital Records resentative on firm letter- a notarized P.O. BoX 25767 http://www.vitalrecordsnm.org head, including atty's release Santa Fe, NM 87125 (866)534-0051 photo ID permitting atty to receive the record New York State No- only person named on $30 Certification Unit the record or that http://www.health.ny.gov Vital Records Section/2nd floor person's parents may (518) 474-3075 800 North Pearl Street request w/ photo ID or (2) Menands, NY 12204 utility or telephone bills or gov't letter issued w/in the past 6 months © 2013 VoteRiders VoteRiders Voter ID Clinics – Training Materials New York City Yes-request as registrant's 1) Client’s $15 NYC Health Department atty on firm letterhead notarized http://www.nyc.gov/ Office of Vital Records and include Rep signature on 125 Worth Street, CN4, Rm.