ALL IN GOOD HEALTH.
4150 Technology Way, Suite 104 ● Carson City, NV 89706 ● (775) 684-4242 ● vitalrecords@health.nv.gov ● dpbh.nv.gov/vitalrecords
Application for Replacement Certificate of Foreign Birth
(Please Print Clearly)
Child’s Information
First Name
Middle Name
Last Name
Sex of Child
Date of Birth (Month, Day, Year)
Place of Birth
Hospital Name
City/Town/Village
Country of Birth
Mother / Parent 1’s
Information
First Name of Mother/Parent 1
Middle Name
Last Name
Last Name Prior To First Marriage
Date of Birth (Month, Day, Year)
State or Foreign Country of Birth
Mother/Parent 1’s
Residence at the Time
of Birth
Number and Street
City
State/Province
ZIP Code
Country of Birth
Father / Parent 2’s
Information
First Name of Father/Parent 2
Middle Name
Last Name
Date of Birth (Month, Day, Year)
State or Foreign Country of Birth
Current Mailing Address
Number and Street
City
State
ZIP Code
Country of Birth
Have you ever applied for a Replacement Certificate of Foreign Birth in another state?
Yes or
No
If yes, which state:
Documents required in addition to this form:
Original certified birth record in non-English language
Original translation to English of the original birth record
Affidavit by the translator attesting to the accuracy of the translation before a
person authorized to administer oaths
U.S. Certificate of Citizenship or U.S. Certificate of Naturalization
Proper filing fee
Applicant’s Relationship to Child:
Applicant’s Signature:
Date Signed:
ALL IN GOOD HEALTH.
4150 Technology Way, Suite 104 ● Carson City, NV 89706 ● (775) 684-4242 ● vitalrecords@health.nv.gov ● dpbh.nv.gov/vitalrecords
How to Establish a Replacement Certificate of Foreign Birth
A Replacement Certificate of Foreign Birth (RCFB) is a translated record of birth established by the State
of Nevada’s Office of Vital Records.
Pursuant to Nevada Revised Statute (NRS) 440.303, “A person whose birth certificate or other evidence
of birth is written in a language other than English, or the parent or guardian of that person, may apply
to the State Registrar for a birth certificate in the English language.”
The purpose of establishing a RCFB is to have a functional birth record in the English language. The
record remains on file in the State of Nevada’s Office of Vital Records, and certified copies may be
purchased in the same fashion as Nevada-born birth certificates.
Provides one certified copy, additional copies are $25.00 each.
Documents required to obtain a Replacement Certificate of Foreign Birth:
The completed application for replacement certificate written in a foreign language
The original certified birth record in a language other than English
An original translation of the original birth record into English
An affidavit by the translator attesting to the accuracy of the translation before a person
authorized to administer oaths
An original certificate issued by the U.S. Citizenship and Immigration Services (USCIS) showing
the person entered the United States legally (U.S. Certificate of Citizenship or U.S. Certificate of
Naturalization)
A $45.00 filing fee
What the Applicant Can Expect - Issuance of Replacement Certificate of Foreign Birth:
• The original foreign born birth record and USCIS certificate will be returned to the applicant with
the RCFB.
• The RCFB will be printed on red security paper.
• The RCFB will read on its face “ISSUED TO REPLACE A BIRTH RECORD FROM IN THE
LANGUAGE” to indicate that this record is a translation of a foreign
record.
