Please note that the following is used to order a CERTIFIED COPY ONLY.

Please print this screen and enclose with Check or Money Order payable to "Barberton Health District".

Fill out and send to:                                                                  

                                                             I would like to order (select one of the options below)

Barberton Health District         Birth Certificate Death Certificate  for:                                                                                    

 Vital Statistics                                  Last Name   

 571 W. Tuscarawas Ave.               First Name  

 Barberton, OH  44203                  Middle         

 330.861-7157                                      Control No. 

Send To:      

Name      

Address 

City             State      Zip 

Phone    

                     Number of copies 1 Copy $20.00 Enclosed 2 Copies $40.00 Enclosed 3 Copies $60.00 Enclosed 4 Copies $80.00 Enclosed 5 Copies $100.00 Enclosed 6 Copies $120.00 Enclosed 7 Copies $140.00 Enclosed 8 Copies $160.00 Enclosed 9 Copies $180.00 Enclosed 10 Copies $200.00 Enclosed