Proof of Eligibility Matrix

Center for Health Statistics

P.O. Box 47814

Olympia, WA 98504

-7814

360

-236-4300

WASHINGTON STATE VITAL RECORDS

ACCEPTABLE PROOFS OF ELIGIBILITY DOCUMENTATION

Page 1 of 10

To request this document in another format, call 1-800-525-0127.

Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.

DOH 422-178 October 2022

Determine which document will best prove a customer’s eligibility to obtain a copy of a birth or death certificate based on their relationship to the person

named in the certificate. This is to be used as a guide and is not exclusive.

PLEASE NOTE: Customer’s identity documents required for all certificate orders.

Identity documents of customer submitting the order is always required for all certificate orders in addition to eligibility documents (in cases of customers

ordering a certificate in which they are named, identity documents may be only document required). If the name on your identity document is different than the

name listed on the certificate or documentation you provided, you may also be asked to submit documentation showing a legal name change.

Applicant's Relationship

to Certificate Holder

Birth Certificate

Long Form Death

Certificate

Short Form Death

Certificate

Certificate of Birth

Resulting in Stillbirth

Fetal Death Certificate

Self

Nothing is needed if

the name on your

identity document

matches the name

listed on the

certificate.

Not applicable

Spouse/Domestic

Partner

Submit a copy of your

marriage or domestic

partnership certificate

that links you to the

subject of record on

the requested

certificate.

Nothing is needed if the

name on your identity

document matches the

spouse/domestic

partner’s name listed on

the death certificate.

If not listed, submit a

copy of your marriage or

domestic certificate, or

divorce certificate that

links you to the subject

of record on the

requested certificate.

Nothing is needed if the

name on your identity

document matches the

spouse/domestic

partner’s name listed on

the death certificate.

If not listed, submit a

copy of your marriage or

domestic partnership

certificate, or divorce

certificate that links you

to the subject of record

on the requested

certificate.

Not applicable

Center for Health Statistics

P.O. Box 47814

Olympia, WA 98504

-7814

360

-236-4300

ACCEPTABLE PROOFS OF ELIGIBILITY CONTINUED

Page 2 of 10

To request this document in another format, call 1-800-525-0127.

Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.

DOH 422-178 October 2022

Applicant's Relationship

to Certificate Holder

Birth Certificate

Long Form Death

Certificate

Short Form Death

Certificate

Certificate of Birth

Resulting in Stillbirth

Fetal Death Certificate

Child

Submit a copy of your

birth certificate that

links you to the subject

of record on the

requested certificate.

Submit a copy of your

birth certificate that

links you to the subject

of record on the

requested certificate.

Submit a copy of your

birth certificate that

links you to the subject

of record on the

requested certificate.

Not applicable

Parent

Nothing is needed if

the name on your

identity document

matches one of the

parent’s names listed

on the birth certificate.

Nothing is needed if the

name on your identity

document matches one

of the parent’s names

listed on the death

certificate.

Nothing is needed if the

name on your identity

document matches one

of the parent’s names

listed on the death

certificate.

Only the individual

who gave birth listed

on the record is

qualified.

Nothing is needed if

the name on your

identity document

matches the individual

who gave birth’s name

listed on the certificate

of birth resulting in

stillbirth.

Nothing is needed if the

name on your identity

document matches one

of the parent’s names

listed on the death

certificate.

Stepparent

Submit a copy of your

marriage or domestic

partnership certificate

that links you to the

person named on the

requested certificate.

Submit a copy of the

birth certificate and a

copy of your marriage or

domestic partnership

certificate that links you

to the person named on

the requested

certificate.

Submit a copy of the

birth certificate and a

copy of your marriage or

domestic partnership

certificate that links you

to the person named on

the requested

certificate.

Not applicable

Center for Health Statistics

P.O. Box 47814

Olympia, WA 98504

-7814

360

-236-4300

ACCEPTABLE PROOFS OF ELIGIBILITY CONTINUED

Page 3 of 10

To request this document in another format, call 1-800-525-0127.

Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.

DOH 422-178 October 2022

Applicant's Relationship

to Certificate Holder

Birth Certificate

Long Form Death

Certificate

Short Form Death

Certificate

Certificate of Birth

Resulting in Stillbirth

Fetal Death Certificate

Stepchild

Submit a copy of your

birth certificate and

parent’s marriage

certificate that links

you to one of the

parents listed on the

requested certificate.

Submit a copy of your

birth certificate and a

copy of your parent’s

marriage or domestic

partnership certificate

that links you to the

person named on the

requested certificate.

Submit a copy of your

birth certificate and a

copy of your parent’s

marriage or domestic

partnership certificate

that links you to the

person named on the

requested certificate.

Not applicable

Sibling

Submit a copy of your

birth certificate that

links you to one of the

parents listed on the

requested certificate.

Submit a copy of the

birth certificate(s) that

links you to the subject

of the record you are

requesting.

Submit a copy of the

birth certificate(s) that

links you to the subject

of the record you are

requesting.

Not applicable

Submit a copy of your

birth certificate that

links you to one of the

parents listed on the

requested certificate.

Grandparent

Submit a copy of your

child's birth certificate

that links you to one of

the parents listed on

the requested

certificate.

Submit a copy of the

birth certificate(s) that

links you to the subject

of the record you are

requesting.

Submit a copy of the

birth certificate(s) that

links you to the subject

of the record you are

requesting.

Not applicable

Submit a copy of your

child's birth certificate

that links you to one of

the parents listed on the

requested certificate.

Grandchild

Submit a copy of your

birth certificate, along

with a copy of your

parent's birth

certificate that links

you to one of the

parents listed on the

requested certificate.

Submit a copy of the

birth certificate(s) that

links you to the subject

of the record you are

requesting.

Submit a copy of the

birth certificate(s) that

links you to the subject

of the record you are

requesting.

Not applicable

Center for Health Statistics

P.O. Box 47814

Olympia, WA 98504

-7814

360

-236-4300

ACCEPTABLE PROOFS OF ELIGIBILITY CONTINUED

Page 4 of 10

To request this document in another format, call 1-800-525-0127.

Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.

DOH 422-178 October 2022

Applicant's Relationship

to Certificate Holder

Birth Certificate

Long Form Death

Certificate

Short Form Death

Certificate

Certificate of Birth

Resulting in Stillbirth

Fetal Death Certificate

Great Grandparent

Submit a copy of your

child's birth certificate,

along with a copy of

your grandchild's birth

certificate that links

you to one of the

parents listed on the

requested certificate.

Submit a copy of the

birth certificate(s) that

links you to the subject

of the record you are

requesting.

Submit a copy of the

birth certificate(s) that

links you to the subject

of the record you are

requesting.

Not applicable

Legal Guardian

"Legal guardian" means

a person who serves as

a guardian for the

purpose of either legal

or custodial matters, or

both, relating to the

person for whom the

guardian is appointed.

The term legal guardian

includes, but is not

limited to, guardians

appointed pursuant to

chapters 11.130

and 13.36 RCW. RCW

70.58A.010(21).

Submit a copy of valid

guardianship papers,

certified by the court,

naming you as the

legal guardian over the

subject of record on

the requested

certificate.

Submit a copy of valid

guardianship papers,

certified by the court,

naming you as the legal

guardian over the

subject of record on the

requested certificate.

Submit a copy of valid

guardianship papers,

certified by the court,

naming you as the legal

guardian over the

subject of record on the

requested certificate.

Not applicable

Center for Health Statistics

P.O. Box 47814

Olympia, WA 98504

-7814

360

-236-4300

ACCEPTABLE PROOFS OF ELIGIBILITY CONTINUED

Page 5 of 10

To request this document in another format, call 1-800-525-0127.

Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.

DOH 422-178 October 2022

Applicant's Relationship

to Certificate Holder

Birth Certificate

Long Form Death

Certificate

Short Form Death

Certificate

Certificate of Birth

Resulting in Stillbirth

Fetal Death Certificate

Next of Kin

as specified in

RCW 11.28.120.

*Specific order*

1) Spouse/domestic

partner

2) Child

3) Parent

4) Sibling

5) Grandchild

6) Niece/Nephew

Not applicable

Submit a copy of your

birth certificate, along

with a copy of your

parent’s birth certificate

that links you to one of

the parents listed on the

requested certificate. As

well as, submit death

certificates proving you

are the only living family

member.

Submit a copy of your

birth certificate, along

with a copy of your

parent’s birth certificate

that links you to one of

the parents listed on the

requested certificate. As

well as, submit death

certificates proving you

are the only living family

member.

Not applicable

Legal Representative

"Legal representative"

means a licensed

attorney representing

either the subject of the

record or qualified

applicant. RCW

70.58A.010(22).

Submit a certified copy

of court records or

legal documentation

that authorizes you to

act on the behalf of

the person named on

the requested

certificate.

Submit a certified copy

of court records or legal

documentation that

authorizes you to act on

the behalf of the person

named on the requested

certificate.

Submit a certified copy

of court records or legal

documentation that

authorizes you to act on

the behalf of the person

named on the requested

certificate.

Not applicable

Submit a certified copy

of court records or legal

documentation that

authorizes you to act on

the behalf of a parent

named on the requested

certificate.

Center for Health Statistics

P.O. Box 47814

Olympia, WA 98504

-7814

360

-236-4300

ACCEPTABLE PROOFS OF ELIGIBILITY CONTINUED

Page 6 of 10

To request this document in another format, call 1-800-525-0127.

Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.

DOH 422-178 October 2022

Applicant's Relationship

to Certificate Holder

Birth Certificate

Long Form Death

Certificate

Short Form Death

Certificate

Certificate of Birth

Resulting in Stillbirth

Fetal Death Certificate

Authorized

Representative

"Authorized

representative" means a

person permitted to

receive a certification

who is:

(a) Identified in a

notarized statement

signed by a qualified

applicant; or

(b) An agent identified

in a power of attorney

as defined in

chapter 11.125 RCW.

RCW 70.58A.010(3).

Submit an Authorized

Representative form or

Power of Attorney

documentation that

authorizes you to act

on the behalf of the

person named on the

requested certificate.

Submit an Authorized

Representative form or

Power of

Attorney documentation

that authorizes you to

act on the behalf of the

person requesting the

certificate. Power of

Attorney ends once

someone dies so cannot

be used for the person

named in the

certificate.

Submit an Authorized

Representative form or

Power of

Attorney documentation

that authorizes you to

act on the behalf of the

person requesting the

certificate. Power of

Attorney ends once

someone dies so cannot

be used for the person

named in the

certificate.

Not applicable

Submit an Authorized

Representative form or

Power of

Attorney documentation

that authorizes you to

act on the behalf of the

person requesting the

certificate. Power of

Attorney ends once

someone dies so cannot

be used for the person

named in the

certificate.

Center for Health Statistics

P.O. Box 47814

Olympia, WA 98504

-7814

360

-236-4300

ACCEPTABLE PROOFS OF ELIGIBILITY CONTINUED

Page 7 of 10

To request this document in another format, call 1-800-525-0127.

Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.

DOH 422-178 October 2022

Applicant's Relationship

to Certificate Holder

Birth Certificate

Long Form Death

Certificate

Short Form Death

Certificate

Certificate of Birth

Resulting in Stillbirth

Fetal Death Certificate

Government

Agency

"Government agencies"

include state boards,

commissions,

committees,

departments,

educational institutions,

or other state agencies

which are created by or

pursuant to statute,

other than courts and

the legislature; county

or city agencies, United

States federal agencies,

and federally recognized

tribes and tribal

organizations. RCW

70.58A.010(16).

Submit an

identification card

issued by your

government agency

that contains your full

name and photograph.

Submit a document or

letter from a

government agency

stating the certificate

will be used in the

conduct of official

duties or certified copy

of court records or

legal documentation

that authorizes you to

act on the behalf of

the person named on

the requested

certificate.

Submit an identification

card issued by your

government agency that

contains your full name

and photograph.

Submit a document or

letter from a

government agency

stating the certificate

will be used in the

conduct of official duties

or certified copy of

court records or legal

documentation that

authorizes you to act on

the behalf of the person

named on the requested

certificate.

Submit an identification

card issued by your

government agency that

contains your full name

and photograph.

Submit a document or

letter from a

government agency

stating the certificate

will be used in the

conduct of official duties

or certified copy of

court records or legal

documentation that

authorizes you to act on

the behalf of the person

named on the requested

certificate.

Not applicable.

Submit an identification

card issued by your

government agency that

contains your full name

and photograph.

Submit a document or

letter from a

government agency

stating the certificate

will be used in the

conduct of official duties

or certified copy of

court records or legal

documentation that

authorizes you to act on

the behalf of the person

named on the requested

certificate.

Center for Health Statistics

P.O. Box 47814

Olympia, WA 98504

-7814

360

-236-4300

ACCEPTABLE PROOFS OF ELIGIBILITY CONTINUED

Page 8 of 10

To request this document in another format, call 1-800-525-0127.

Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.

DOH 422-178 October 2022

Applicant's Relationship

to Certificate Holder

Birth Certificate

Long Form Death

Certificate

Short Form Death

Certificate

Certificate of Birth

Resulting in Stillbirth

Fetal Death Certificate

Courts

Submit an

identification card

issued by your

government agency

that contains your full

name and photograph.

Submit a document or

letter from a

government agency

stating the certificate

will be used in the

conduct of official

duties or certified copy

of court records or

legal documentation

that authorizes you to

act on the behalf of

the person named on

the requested

certificate.

Submit an identification

card issued by your

government agency that

contains your full name

and photograph.

Submit a document or

letter from a

government agency

stating the certificate

will be used in the

conduct of official duties

or certified copy of

court records or legal

documentation that

authorizes you to act on

the behalf of the person

named on the requested

certificate.

Submit an identification

card issued by your

government agency that

contains your full name

and photograph.

Submit a document or

letter from a

government agency

stating the certificate

will be used in the

conduct of official duties

or certified copy of

court records or legal

documentation that

authorizes you to act on

the behalf of the person

named on the requested

certificate.

Not applicable

Submit an identification

card issued by your

government agency that

contains your full name

and photograph.

Submit a document or

letter from a

government agency

stating the certificate

will be used in the

conduct of official duties

or certified copy of

court records or legal

documentation that

authorizes you to act on

the behalf of the person

named on the requested

certificate.

Center for Health Statistics

P.O. Box 47814

Olympia, WA 98504

-7814

360

-236-4300

ACCEPTABLE PROOFS OF ELIGIBILITY CONTINUED

Page 9 of 10

To request this document in another format, call 1-800-525-0127.

Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.

DOH 422-178 October 2022

Applicant's Relationship

to Certificate Holder

Birth Certificate

Long Form Death

Certificate

Short Form Death

Certificate

Certificate of Birth

Resulting in Stillbirth

Fetal Death Certificate

Title Insurer or Title

Insurance Agent

Not applicable

Submit official

document or letter from

organization that

authorizes you as the

title insurer or title

insurance agent

handling a transaction

on behalf of the person

named on the requested

certificate.

Not applicable

Funeral director or

funeral establishment

within 12 months from

the date of death

"Funeral director"

means a person licensed

under chapter 18.39

RCW as a funeral

director. RCW

70.58A.010(14).

"Funeral establishment"

means a place of

business licensed under

chapter 18.39 RCW as a

funeral establishment.

RCW 70.58A.010(15).

Not applicable

Submit official business

document identifying

you are with the funeral

establishment listed on

the requested

certificate.

Submit official business

document identifying

you are with the funeral

establishment listed on

the requested

certificate.

Not applicable

Submit official business

document identifying

you are with the funeral

establishment listed on

the requested

certificate.

Center for Health Statistics

P.O. Box 47814

Olympia, WA 98504

-7814

360

-236-4300

ACCEPTABLE PROOFS OF ELIGIBILITY CONTINUED

Page 10 of 10

To request this document in another format, call 1-800-525-0127.

Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.

DOH 422-178 October 2022

Applicant's Relationship

to Certificate Holder

Birth Certificate

Long Form Death

Certificate

Short Form Death

Certificate

Certificate of Birth

Resulting in Stillbirth

Fetal Death Certificate

Person who has right to

control disposition of

human remains under

RCW 68.50.160 named

on the record within 12

months from the date

of death

Not applicable

Submit documentation,

such as court records or

other legal

documentation that

authorizes you to have

the right to control the

disposition of human

remains of the person

named on the requested

certificate.

Submit documentation,

such as court records or

other legal

documentation that

authorizes you to have

the right to control the

disposition of human

remains of the person

named on the requested

certificate.

Not applicable

Determination related

to the death or

protection of a personal

or property right

related to the death

Not applicable

Submit documentation

such as, but not limited

to, court records or

other legal

documentation that the

requested certificate

will be used for the

determination related to

the death or protection

of a personal or

property right related to

the death.

Not applicable