Vital Records Request Form
Birth and death certificates ordered online MUST BE PICKED-UP at Grays Harbor County Public Health Department; certificates ordered online cannot be mailed.
To order a birth or death certificate online, complete the form below and click "Submit Form." Please complete all applicable fields as incomplete requests cannot be processed. Requests received by 11 a.m. will be ready for pick-up after 2 p.m. the same day. Requests received after 11 a.m. will be ready for pick-up after 2 p.m. the following business day.
You may call Julie at (360) 532-8631 x.275 to confirm receipt of your online order.
Payment is due at time of pick-up. The cost is $20 each certificated copy payable by cash, local check or money order. Sorry, no out-of-county checks, credit cards or debit cards accepted.
I am requesting: Birth CertificateDeath Certificate
Name as it appears on birth or death certificate:
Date of birth or death (mm/dd/yyyy): *Please note: Grays Harbor County Public Health Department can process vital records requests for births that occurred in Washington State and only if the person was born on January 1, 1921 or after; death certificates are only available for deaths that occurred in Grays Harbor County during the past 60 days.
City of birth or death:
County of birth or death:
Hospital/Nursing Home/Other location of birth or death:
Father's full name (for birth certificate only):
Mother's MAIDEN name (for birth certificate only):
Number of certificated copies requested ($20 each copy): 12345678910
Name of person requesting birth or death certificate:
Relationship to deceased (for death certificates only, optional):
Daytime phone number (please include area code):
