The Application for Birth Record and Certificate of Identity (form 76A639B) is the form the Los Angeles County Registrar-Recorder/County Clerk (RR/CC) uses for mail requests for a certified copy of a birth record. It is one of the paths to a Los Angeles County birth certificate, and it covers only births that occurred in Los Angeles County. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the Certificate of Identity must still be signed in front of a notary, and the package goes to the RR/CC by mail.
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What is 76A639B?
The Application for Birth Record and Certificate of Identity is the Los Angeles County Registrar-Recorder/County Clerk (RR/CC) form used to request a certified copy of a birth record by mail, together with the sworn statement that proves the requester is entitled to an authorized copy.
The packet has three parts. The first page, form 76A639B, is the Application for Birth Record: it asks for the certificate type, number of copies, the registrant's birth details, the parents' birth names, your relationship to the registrant and your own mailing address. The second page is a Special Notice to Veterans with an affidavit for a free certified copy in a veterans' benefit claim. The third page, form R1995, is the Certificate of Identity/Sworn Statement, which is signed before a notary and carries a Certificate of Acknowledgement.
You choose one of two copy types. An authorized copy is issued to the persons listed in Health and Safety Code 103526 and requires the notarized Certificate of Identity when requested by mail. An informational copy can be issued to anyone who is not authorized, and carries the words "INFORMATIONAL, NOT A VALID DOCUMENT TO ESTABLISH IDENTITY" across its face.
The RR/CC can provide copies only for births that occurred in Los Angeles County. For births elsewhere, the agency page points to a separate process.
Who needs to file 76A639B?
Anyone who wants a certified copy of a Los Angeles County birth record by mail uses this application. Which copy you request depends on who you are.
An authorized copy is available to:
- the registrant, or a parent or legal guardian of the registrant;
- a child, grandparent, grandchild, sibling, spouse or domestic partner of the registrant;
- an attorney representing the registrant or the registrant's estate, or any person or agency empowered by statute or appointed by a court to act for the registrant or the estate;
- a party entitled to the record by court order, or an attorney or licensed adoption agency acting under Family Code Section 3140 or 7603;
- a member of a law enforcement agency or a representative of another governmental agency conducting official business, as provided by law.
If you are not authorized, or do not want to submit the notarized Certificate of Identity, you can request an informational certified copy instead. It cannot be used for legal purposes or to establish identity.
Veterans applying for a veteran's pension or certain other Veterans Administration benefits may qualify for a free certified copy by completing the affidavit on the Special Notice to Veterans. It does not apply to Social Security or other civilian benefits, even for a veteran.
Do not use this form for a birth outside Los Angeles County; the RR/CC cannot provide those records.
When to file 76A639B
Submit the application whenever you need a certified copy of a Los Angeles County birth record; neither the form nor the agency page sets a filing deadline. Have the notarized Certificate of Identity ready first if you want an authorized copy, because the agency page warns that an un-notarized certificate will delay the process.
After the RR/CC receives your request, the record is mailed within 20 business days from the date of receipt. The agency page says no requests are taken by telephone, so the mailed application is the way to start this request.
Documents you need
- Certificate of Identity/Sworn Statement (form R1995), signed in the presence of a notary: required with a mail request for an authorized copy; not needed for an informational copy.
- Check or money order payable to the Registrar-Recorder/County Clerk for the fee; no cash, E-Checks, temporary checks or foreign checks (Canada and Mexico excepted).
- Veterans' affidavit on the Special Notice to Veterans page: only if you are applying for a free certified copy for a veteran's pension or certain other Veterans Administration benefits.
How to fill out 76A639B
Choose the certificate type
Under CERTIFICATE TYPE, mark whether you are requesting an AUTHORIZED copy or an INFORMATIONAL copy. Enter the NUMBER OF COPIES, and check the adopted box if the registrant was adopted.
Leave recorder boxes blank
Do not write in the areas marked FOR RECORDER USE ONLY, such as the Searched and Doubled boxes; they are for the RR/CC.
Enter the date of birth
In Date of Birth, give the Month, Day and Year of the registrant's birth. The birth must have occurred in Los Angeles County.
Enter the registrant's name and city
Write the name given at birth or on the birth record (first, middle, last) and the CITY OF BIRTH. If the registrant was adopted, enter the adopted name.
Enter the parents' birth names
Fill in BIRTH NAME OF PARENT #1 and BIRTH NAME OF PARENT #2, using the names as they were at birth.
State your relationship
Under RELATIONSHIP TO REGISTRANT, write how you are related, based on the list of entitled persons at the top of the form.
Complete the perjury statement
Print your name on the "I ___ certify (or declare)" line, then add the date, your signature, your DL/ID number and your phone number.
Enter your mailing address
Under APPLICANT NAME, STREET ADDRESS and CITY/STATE/ZIP, print your name and the address where the copy should be mailed.
Complete the veterans affidavit if it applies
Only for a free copy in a veteran's benefit claim, fill in the agency, type of benefit, date, signature of the veteran or authorized agent, relationship of agent and address. Otherwise skip this page.
Fill in the Certificate of Identity
For an authorized copy, enter the name(s) on the certificate and your relationship, and print your name. Do not sign until you are in front of the notary, who completes the date, place and Certificate of Acknowledgement.
Review, download and assemble
Check that every entry matches the birth record, then download or print the completed PDF from FillingPDF. Sign where required, have the Certificate of Identity notarized, add your payment and submit it as described under How to submit.
How to submit 76A639B
Send the completed application by mail to the Los Angeles County RR/CC; the agency page lists no other channel for this form and says no requests are available by telephone.
- Mail: Registrar-Recorder/County Clerk, Birth, Death and Marriage Records Section, PO Box 489, Norwalk, CA 90651-0489. The form's header gives the telephone number (800) 201-8999.
- What to include: the signed application; for an authorized copy, the Certificate of Identity signed in front of a notary; and payment.
- Payment: a fee applies. Pay by check or money order made payable to the Registrar-Recorder/County Clerk. The agency does not accept E-Checks, temporary checks or foreign checks (Canada and Mexico excepted), and says not to send cash. A rejected payment method means the request is sent back. Call the RR/CC for the current amount.
- Fee note: the fee for the first copy of each record is nonrefundable. If no record is found, the RR/CC issues a "No Record Statement."
- Living outside California: have the notary strike out "California" on the Certificate of Identity and write the state where it is notarized; the agency will accept it.
FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Mailing a request for an authorized copy without the notarized Certificate of Identity; the form says mail requests for authorized copies must be accompanied by it, and an un-notarized one delays the process.
- Signing the Certificate of Identity before you are in front of the notary; the form says it must be signed in the presence of a notary.
- Requesting a record for a birth outside Los Angeles County; the form says copies are provided only for births that occurred there.
- Paying with cash, an E-Check, a temporary check or a foreign check; the request is returned when one of the last three arrives.
- Checking the authorized box when you are not on the list of entitled persons; unauthorized requesters receive an informational copy.
- Using the veterans' affidavit for Social Security or other civilian benefits; the form says it does not apply, even to veterans.
- Not giving the adopted name and parents' information, or not checking the box, when the registrant was adopted.
- Writing illegibly; the form asks you to print all information legibly, including your name and mailing address.
Frequently asked questions
How do I get a Los Angeles County birth certificate by mail?
Complete the Application for Birth Record and Certificate of Identity, sign it, have the Certificate of Identity notarized if you want an authorized copy, and mail it with payment to the RR/CC at PO Box 489, Norwalk, CA 90651-0489. The record is mailed within 20 business days of receipt.
Do I need a notary for the birth record application?
For an authorized copy requested by mail, yes: the Certificate of Identity must be signed in the presence of a notary. For an informational copy you can skip it, but that copy cannot be used for legal purposes or to establish identity.
Who can get an authorized copy of a birth certificate in Los Angeles County?
The registrant, a parent or legal guardian, a child, grandparent, grandchild, sibling, spouse or domestic partner, an attorney or court-appointed representative, and certain court-ordered, adoption-agency and government requesters. Everyone else can request an informational copy.
What is the difference between an authorized and an informational copy?
An authorized copy is issued to entitled persons and needs the notarized Certificate of Identity. An informational copy can go to anyone, but it is imprinted "INFORMATIONAL, NOT A VALID DOCUMENT TO ESTABLISH IDENTITY" and cannot be used for legal purposes.
How do I pay for a birth record by mail?
A fee applies, and you pay by check or money order payable to the Registrar-Recorder/County Clerk. E-Checks, temporary checks and foreign checks (except Canada and Mexico) are rejected, and cash should not be sent. Call (800) 201-8999 for the current amount.
Can I get the record if I live outside California?
Yes. Have the notary strike out "California" on the Certificate of Identity and write the state where it is notarized; the agency will accept it with that change. The Certificate must still accompany the application for an authorized copy.
Can I fill out the birth record application online on FillingPDF?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is independent of the RR/CC and does not file it: you still sign, notarize the Certificate of Identity and mail the package to the agency.
Is a free birth certificate available for veterans?
Possibly. A veteran applying for a veteran's pension or certain other Veterans Administration benefits may qualify by completing the affidavit on the Special Notice to Veterans; the copy is mailed to the benefit agency. It does not apply to Social Security or other civilian benefits.
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