How to Fill Out the Mississippi Birth Certificate Application (Form 522)

To get a certified copy of a Mississippi birth certificate, complete the Application for Certified Copy of Birth Certificate (Form 522), attach a copy of your photo ID, and submit it with a $17 fee to the Mississippi State Department of Health Bureau of Vital Records. You can mail the Mississippi birth certificate application (Form 522), bring it to the walk-in office in Ridgeland, or place the order online through VitalChek. Mail orders are processed in seven to ten business days.¹

Check That You’re Eligible Before You Start

Mississippi restricts birth records to people with a “legitimate and tangible interest” in the record.² Form 522 spells that out as the person named on the certificate, their spouse, parent, grandparent, sibling, child, grandchild, guardian, or legal representative.³

If you’re applying as someone other than the person on the certificate, the form asks for your relationship and may ask for documentation of it. Legal representatives should be ready to show a court order, power of attorney, or similar proof of authority.

Filling Out Form 522

Download Form 522 as a PDF from the MSDH website or pick one up at a county health department office.⁴ Print clearly. Illegible handwriting is one of the easiest ways to slow your request down.

The top half of the form asks about the birth record itself:³

Full name on the birth record — first, middle, and last as recorded at birth.
If the name has changed since birth, the original name too.
Date of birth, with a four-digit year.
Place of birth: county, city, and state. Get the county right; the office uses it to find the record.
Sex, and the race of the parents.
Mother’s or parent’s full name, including maiden name.
Father’s or parent’s full name.
State file number, only if you already know it. Leave it blank otherwise.

The bottom half is about you: your name, your relationship to the person on the certificate, the purpose of the request, your signature, the date, and your full mailing address including a phone number. A mailing address is required no matter how you plan to receive the certificate.³ Sign it. An unsigned form gets returned.

The ID Copy You Need to Attach

Every application must include a copy of the requester’s valid photo ID.⁴ Any one of these works on its own:

Photo driver’s license
State-issued photo ID
Employment ID
School, college, or university ID
U.S. military ID
Tribal ID
Alien registration or permanent resident card
Temporary resident card
U.S. passport

Without a primary photo ID, you can substitute two documents from a secondary list: a Social Security card, a utility bill showing your address, a Medicaid card, a SNAP/EBT card showing your address, a work identification card, or a Veteran’s Universal Access ID card.³ Two are required. A Social Security card by itself does not qualify as photo ID.

Make sure the copy is legible. A dark, blurry photocopy is a common reason applications come back.

Fees and How to Pay

The first certified copy costs $17. Each additional copy of the same record ordered at the same time is $6.⁴ The $17 covers the search of the records and is nonrefundable whether a certificate is found or not.³

If you know you’ll need several copies, order them together. Placing separate requests later means paying the $17 first-copy fee each time.

Payment options depend on how you submit:

By mail: bank cashier’s check or a bank or postal money order made payable to Mississippi Vital Records. No cash and no personal checks.⁴
In person: cash, money order, cashier’s check, or credit card. No personal checks.¹
Online or phone: American Express, Discover, MasterCard, or Visa through VitalChek, which adds its own processing fee on top of the $17.⁵

Where to Submit Form 522

By Mail

Send the signed application, a copy of your photo ID, and payment to:⁴

Mississippi Vital Records
P.O. Box 1700
Jackson, MS 39215-1700

In Person

The walk-in office is at 222 Marketridge Drive in Ridgeland, off Highland Colony Parkway. The customer service window is open Monday through Friday, 8:00 a.m. to 4:00 p.m.⁶

Online or by Phone

MSDH uses VitalChek for online and telephone orders. It’s the fastest option and includes an expedited UPS delivery choice, but you’ll pay a service fee on top of the state’s $17. To skip that extra cost, mail the application directly to MSDH.⁵

How Long It Takes

Mail: seven to ten business days of processing, then U.S. Postal Service delivery to the address on your application. MSDH asks that you wait four weeks after mailing before calling to check on your order.¹
In person: typically same day at the Ridgeland window during business hours.
Online or phone through VitalChek: three to five business days, with express UPS shipping available.¹

Why Applications Get Rejected

Applications come back most often for three reasons: the fee is wrong, the ID copy is missing or illegible, or the form is incomplete or unsigned. When that happens, the office returns your paperwork with a note about what to fix. Before you seal the envelope, check three things: the form is signed, the ID copy is readable, and the payment is a cashier’s check or money order for the correct amount.

If the Birth Certificate Has an Error

Form 522 is only for ordering a copy of the record as it exists. If the certificate itself has a mistake — a misspelled name, a wrong date of birth, incorrect parent information — you’ll need a different form: the Affidavit to Amend Mississippi Certificate of Live Birth (Form 1126). The fee is $28 and includes one certified copy of the amended record; additional copies ordered at the same time are $6.⁷ The amendment process has its own signature, notarization, and documentary-evidence requirements, so start there rather than submitting Form 522 if you need a correction.

1
Mississippi State Department of Health. Questions and Answers About Vital Records
2
Justia. Mississippi Code 41-57-2 – Certain Persons Not Prohibited From Having Access to Records
3
Mississippi State Department of Health. Application for Certified Mississippi Birth Certificate
4
Mississippi State Department of Health. Birth Certificate Application Instructions
5
Mississippi State Department of Health. Order Birth, Death or Marriage Records Online or by Phone
6
Mississippi State Department of Health. Vital Records
7
Mississippi State Department of Health. Affidavit to Amend Mississippi Certificate of Live Birth