Ordering Certificate of Stillbirth By

Regular Mail

New ID requirements: Due to the rise in identity theft and other fraudulent use of vital records, acceptable ID is limited. You must provide a government (state or federal) issued photo ID. This can be issued by the U.S. or other country of residence.

Examples of acceptable IDs (must be current):

  • Photocopy of driver's license
  • Photocopy of state ID card
  • Photocopy of passport or visa
  • Photocopy of military ID

If you do not have a government issued photo ID, you must send photocopies of any TWO of the following:

  • Social security number
  • Bank statement with current address
  • Car registration or title with current address
  • Utility bill with current address
  • Pay stub (must include your name, social security number plus name and address of business)

The cost is $15.00 for each certified copy. By state law, the initial $15.00 fee for a certified copy of a Stillbirth is a five-year record search fee – one certified copy is issued if the record is found and if not found, the fee is retained. Payment can be a check or money order made payable to "Kansas Vital Statistics."

Click on below selection for Certificate of Birth Resulting in Stillbirth application form:

NOTE: The documents listed below with can be opened using Adobe Acrobat Reader, filled out on-line, and printed. The data will not be saved within the document.

Some files linked from this page require the Adobe Acrobat Reader® plug-in. For assistance with download, installation, or use of the plug-in, please contact Adobe Systems, Inc.®.

Application in Adobe

If you cannot provide complete information, provide as much as possible. We must have sufficient information to conduct a record search for the correct record. If the exact date of the birth is unknown, state a consecutive five-year search span (more may be specified, but each five-year span costs $15.00).

Submit a completed, signed application form or send a letter with the following information:

  • Specify you are requesting a Stillbirth certificate
  • Indicate the number of certified copies your are requesting
  • Full name as listed on the Stillbirth
  • Date of Delivery (month, day, year)
  • Sex (male or female)
  • Place of delivery (city, county) – Must be Kansas
  • Mother's maiden name
  • Father's full name
  • Please indicate if you are wanting a Stillbirth/Fetal Death (includes cause of death) or Birth Resulting in Stillbirth (Does NOT include cause of death)
  • Your relationship to the person named on the stillbirth certificate
  • Reason you are requesting the certificate (we ask this so that we can provide appropriate service for your needs)
  • Your daytime phone number
  • Your mailing address
  • Place your handwritten signature on the request
  • You MUST include a photocopy of a government issued ID or two of the documents listed above.
  • Enclose a check or money order in U. S. dollars made payable to "Kansas Vital Statistics." DO NOT SEND CASH.
  • Enclose a business size self-addressed stamped envelope for each request of a different record.

Mail the request to:
Office of Vital Statistics
Curtis State Office Building
1000 SW Jackson, Suite 120
Topeka, KS 66612-2221
Requests with insufficient information, incorrect payment amount, or made by ineligible requestors will be returned to the requestor along with a form explaining why the request was returned.