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Kentucky homeless-status affidavit for a fee-exempt birth record

Official owner Kentucky Office of Vital Statistics

Provider-assisted affidavit and mailed packet requesting one fee-exempt certified birth record for a qualified Kentucky-born person.

What problem this helps solve

Provider-assisted affidavit and mailed packet requesting one fee-exempt certified birth record for a qualified Kentucky-born person.

Who completes it: Authorized homeless-services provider or designated education/college financial-aid official with knowledge of status; requester must be lawfully entitled.

What this does not prove

Official instructions and the person's notice control; an application is not an eligibility or approval decision.

Dated source check

Official destination checked

Two-pageVS-41Rev12.2025 read and matched to current maintained form directory; month precision normalized 2025-12-01.

Last checked Sep 30, 2026. A working link does not establish the current edition, suitability, agency acceptance, or service availability.

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Direct document

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Use the official pathway

NOLO's preparation notes summarize the dated sources in this record. Follow the agency's official instructions and current edition when they differ.

1. Check that this route fits

Stage and purpose
Request birth-record fee exemption
Who completes it
Authorized homeless-services provider or designated education/college financial-aid official with knowledge of status; requester must be lawfully entitled.
Jurisdiction
Kentucky
Application mode
Provider-completed affidavit; Print and mail packet

2. Prepare before starting

  • Registrant born in Kentucky and qualifies under form's homeless definitions.
  • Find a lawful authorized requester/attester with personal knowledge.

Documents named by the source

  • Printed VS-37 birth application.
  • Requester agency photo ID or state driver license plus business card/organization name-tag evidence as prescribed.
Fees and fee waivers
One qualifying fee-exempt birth record per application; other order requirements remain.
Account
No online account requirement stated.
Appointment
UNKNOWN — provider's availability/authority must be established.
Signature
Qualified provider's agent signs and dates sworn/affirmed verification; no independent notary requirement is stated.
Third-party certification or assessment
Authorized provider must verify homeless status and sign the affidavit.

3. Follow official submission instructions

Read official instructions
  • Mail affidavit, printed VS-37 and requester ID to OVS,275 E Main Street1E-A,Frankfort KY40621-0001

4. Get help or an accommodation

Languages: English source read; other versions UNKNOWN.

Accessibility: External source conformance was not evaluated; request agency assistance for an inaccessible process.

5. Know the supported next step

  • Keep packet copy and follow OVS questions/order instructions.

Restrictions and unresolved details

  • No exemption for out-of-state birth through Kentucky OVS.
  • Does not waive other VS-37 requirements.
  • A directory entry does not prove a particular provider will attest.

Official instructions and the person's notice control; an application is not an eligibility or approval decision.

Fill out the official form

Use these notes alongside the official instructions. Complete your answers on the agency's form.

Document format: PDF with fillable fields. Checked 2026-10-05. Signature support and agency acceptance still need confirmation.

  1. The qualifying provider writes its organization name.

    Source and date checked
    Entity Name of Homeless Services Provider Furnishing Verification of Homelessness:

    Official source · Checked 2026-10-05

  2. The provider completes its contact fields and address.

    Source and date checked
    Phone Number: E-mail:

    Official source · Checked 2026-10-05

  3. Print the name of the provider’s agent.

    Source and date checked
    Printed Name of Agent for Provider

    Official source · Checked 2026-10-05

  4. Write the name of the person whose birth record is requested.

    Source and date checked
    Printed Name of Homeless Person or Homeless Child or Youth

    Official source · Checked 2026-10-05

  5. The provider’s agent signs and dates the affidavit.

    Source and date checked
    Signature of Agent for Provider Date

    Official source · Checked 2026-10-05

  6. Include the printed birth application and the requester’s required identity proof.

    Source and date checked
    Mail the affidavit, printed application, and copy of the requester’s identification to:

    Official source · Checked 2026-10-05

  7. Ask a director or designee of a governmental or nonprofit agency funded to serve homeless people.

    Source and date checked
    A director or designee of a governmental or nonprofit agency that receives public or private funding to provide services to homeless people;

    Official source · Checked 2026-10-05

  8. Ask a designated school homeless liaison, school social worker or school counselor.

    Source and date checked
    A local educational agency liaison for homeless children and youths designated pursuant to 42 U.S.C. sec. 11432(g)(1)(J)(ii), or a school social worker or school counselor;

    Official source · Checked 2026-10-05

  9. Ask the director or designee of a federal TRIO or Gaining Early Awareness and Readiness for Undergraduate Program.

    Source and date checked
    The director or director's designee of a federal TRIO Program or a Gaining Early Awareness and Readiness for Undergraduate Program; or

    Official source · Checked 2026-10-05

  10. Ask a financial aid administrator at an institution of higher education.

    Source and date checked
    A financial aid administrator for an institution of higher education.

    Official source · Checked 2026-10-05

Where to submit

Office of Vital Statistics, 275 East Main Street 1E-A, Frankfort, KY 40621-0001

Source and date checked
Office of Vital Statistics 275 East Main Street 1E-A Frankfort, KY 40621-0001

Official source · Checked 2026-10-05

Fees
Unknown — confirm the current instructions with the agency.
Fee waivers

KRS 213.141(4)(d): scope and verification requirements as written; do not promise individual eligibility.

Source and date checked
(d) No fee or compensation shall be allowed or paid for furnishing a certificate of birth to a homeless individual as defined in KRS 198A.700, or a homeless youth as defined in 42 U.S.C. sec. 11434a(2) who is under twenty -five (25) years of age, provided the homeless individual or homeless youth has been verified as homeless by at least one (1) of the following:

Official source · Checked 2026-10-05

Restrictions
Unknown — confirm the current instructions with the agency.

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Official title
Kentucky homeless-status affidavit for a fee-exempt birth record
Form number
VS-41
Program
Fee-exempt Kentucky birth record
Jurisdiction
Kentucky
Revision / edition
Dec 2025
Who completes it
Authorized homeless-services provider or designated education/college financial-aid official with knowledge of status; requester must be lawfully entitled.
Signature
Qualified provider's agent signs and dates sworn/affirmed verification; no independent notary requirement is stated.
Submission methods
Mail affidavit, printed VS-37 and requester ID to OVS,275 E Main Street1E-A,Frankfort KY40621-0001
Supporting documents
  • • Printed VS-37 birth application.
  • • Requester agency photo ID or state driver license plus business card/organization name-tag evidence as prescribed.
Languages
English source read; other versions UNKNOWN.
Accessibility
External source conformance was not evaluated; request agency assistance for an inaccessible process.

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Source note: Official instructions and the person's notice control; an application is not an eligibility or approval decision.

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