This is an official request for an aspect of the Nash County Register of Deeds Vital Record. The information contained in this request should be considered private. Please complete all information in full and then finalize the order process through payment of the 'order fee'.

The fee payment will be paid through Permitium Payments.  The charge will show on your credit card statement as 'PermVitalRecs'. This is a secure and trusted provider of payment services.

Please Enter The Full Name On The Birth Certificate:

Information Related To Birth:

Parent Names As Listed on Birth Certificate:

Please Enter The Requestor's Name:


Requestor's Current Residence Address: (this may be different than the mailing address)

Requestor's Current Mailing Address: (if different from residence address)

Requestor's Contact Telephone Numbers: (###-###-####)

Requestor's Driver's License: (or other State Issued ID)

Requestor's Email:

Please attach your photo identification

I will mail or fax these documents
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Select Delivery Method:

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The individual listed on the Birth Certificate is:









Select The Information Type(s) Requested:


Total Fee:
$0
AUTHORIZATION NOTIFICATION:
My initials below constitute an electronic signature and authorizes the Nash County Register of Deeds Department of Vital Records to release information and / or my vital record and confirms I have completed all sections accurately and truthfully, including information verifying my identity. I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other party or agency without my expressed written consent except under authority of North Carolina General Statutes 130A-26A, and 130A-93.
 
I have enclosed the correct fees and understand that they are nonrefundable. I understand that an incomplete form will not be processed and will be considered closed after expiration of the 30 day notification window. I declare under penalty of perjury that the foregoing is true and correct.
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