BIRTH CERTIFICATE
REQUEST FORM
Filter Type:
Name at Birth:
Date of Birth:
Mother's Name:
Father's Name:
Place of Birth:
Sex:
Requestor's Relationship:
I certify that the information above is true and correct. Yes
Name of Requestor:
Mailing Address:
Daytime Phone Number:
How would you like to receive this form?


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Any unauthorized use of the information being provided
will result in prosecution to the fullest extent of the law.
Our office, in conjunction with our software vendor,
has made every attempt to eliminate social security
numbers from the on-line version of our public records. 
However, should citizens find that their social security
number is still visible on-online; we ask that they call
our office at 304-728-3215 for immediate removal
of that number.
 
 
Who can get Birth, Marriage or Death Certificates?
   Death    
 
 
                    
 
 
 
 
               
 
         
 
 
West Virginia Lottery
Table Games
The Office of the County Clerk
does not endorse either position
 
 link
 
  link
 
 
 
 
 
 
 
 
 
 
                      
             
 
 
Jefferson County Republican Website:
www.jcwvgop.org
 
Jefferson County  Young Republican:
http://groups.google.com/group/jcyrep
 
Jefferson County Democratic Website:
http://www.decjc.org/
 
To Candidates:
Statewide candidates who would like to have their profiles added our candidate page are invited to forward their information to mpagano@jeffersoncountywv.org