Authority: IC 16-19-3-4; IC 16-37-1-3

Affected: IC 16-37

Sec. 2. The applicant of a birth certificate shall provide the following to the state registrar upon request:

1. (1) The following information about the individual:

   1. (A) Full name at birth.
   2. (B) City or county of birth.
   3. (C) Date of birth.
   4. (D) Parent's full names, including mother's maiden name.
2. (2) Purpose for which record is to be used.
3. (3) Guardianship papers, if applicable.

4. (4) The following information about the applicant:

   1. (A) Documentation to verify relationship to the individual.
   2. (B) Written signature.
   3. (C) Photocopy of signature identification of the applicant.
   4. (D) Address and telephone number.

5. (5) If the individual is under eighteen (18) years of age and is also the applicant, the following additional information must also be provided to the state registrar:

   1. (A) Written signature of parent or guardian.
   2. (B) Photocopy of signature identification of parent or guardian.
   3. (C) Telephone number of parent or guardian.
6. (6) Other documentation as requested by state registrar.
7. (7) A check or money order payable to the Indiana department of health for the correct amount required by law.

(Indiana Department of Health; 410 IAC 18-3-2; filed Jul 31, 2008, 4:20 p.m.: 20080827-IR-410070821FRA; readopted filed Sep 10, 2014, 2:08 p.m.: 20141008-IR-410140299RFA; readopted filed Sep 10, 2020, 2:11 p.m.: 20201007-IR- 410200404RFA; errata filed Jul 28, 2021, 9:48 a.m.: 20210811-IR-410210318ACA)