In PersonEdit

1. Go to Bureau of Vital Statistics Office.
2. Complete the request form: Commemorative Certificate of Stillbirth Request Form.
3. Submit the request form and required documents.
4. Receive the certificate from Juneau office. It can only be issued at this office.

By MailEdit

Mail the completed application form with a money order, a personal check. Checks must be preprinted with your name and address. Send to

Bureau of Vital Statistics

P.O. Box 110675

Juneau, AK 99801-0675

• A valid government-issued picture identification which bears your signature.
• A state issued Driver's License that includes a photograph
• Valid Passport
• Military ID
• State Issued ID

• Bureau of Vital Statistics

P.O. Box 110675

Juneau, AK 99801?0675

Phone: 907.465.3391

Fax: 907.465.3618

Parents listed on the record are eligible to request the certified copies of a certificate of Birth Resulting in Stillbirth.

Certified copy: $20.00 each

Explain the time until which the certificate/document is valid.
e.g. Birth Certificate Valid Forever

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• For any stillborn child in Alaska, the Bureau of Vital Statistics will issue a Certificate of Birth Resulting in Stillbirth (CBRS) upon the request of a parent named on a fetal death certificate.
• A named parent must submit an application and a photocopy of a valid government issued identification, such as drivers license, military ID, passport, or state issued ID.
• This documentation is required to determine their eligibility in obtaining the Certificate of Birth Resulting in Stillbirth.
• The certificate can only be issued from the Juneau office. Same day service or expedited service is not available for these request, you can send the request by mail with check or money order.
• The check or money are payable to "Bureau of Vital Statistics ".
• Please note there is a $30.00 NSF fee for returned checks.
• A request form can be downloaded here: Commemorative Certificate of Stillbirth Request Form.

• Baby's name
• Date of Delivery
• City or village of Delivery
• Hospital or Facility of Delivery
• The mother's maiden name
• The father's name
• Relationship to the child
• Signature
• Contact Phone

If you want to obtain certified copy of birth resulting in stillbirth you can obtain one with following the procedure given below.

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Please explain what are other uses of obtaining this document/certificate.
e.g. Birth Certificate can be used as proof of identity.

Bureau of Vital Statistics - Alaska
http://www.hss.state.ak.us/dph/bvs/birth/stillborn.htm

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