What is Form DOH-296A used for?

It is an application to a local registrar for a copy of a birth record. It collects birth details, the requested number of copies, the purpose, and applicant information.

Who fills out the birth record copy application?

The person requesting the record completes the application. It asks for their relationship to the person whose record is requested and provides an option for an attorney to identify a client.

Do I need a notary for the birth record copy application?

No. This application is signed and dated without a notary, and it identifies no notarized or sworn attachment.

Westfield, NY · Chautauqua County

No notary required

Application to Local Registrar for Copy of Birth Record

The DOH-296A is an application for a local registrar to issue a birth-record copy, completed by someone requesting their own or another person’s record.

What this form is

Use this New York State Department of Health form to request a copy of a birth record from a local registrar. It asks for the subject’s name, date and place of birth, parents’ names, number of copies requested, purpose, applicant relationship and contact details, and the applicant’s signature and address.

Who needs it

Anyone requesting a copy of a birth record from a local registrar uses this application to provide details about the record and the applicant.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details.

About notarization

This application is signed and dated without a notary; it identifies no notarized or sworn attachment, so the applicant just signs and dates it.

How to submit this form

1
Download The Application
Download Form DOH-296A for a copy of a birth record.
2
Complete The Application
Enter the birth and applicant details requested, including the purpose and number of copies.
3
Review And Sign
Check the information and sign and date the application.
4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.

Frequently asked questions

What is Form DOH-296A used for?: It is an application to a local registrar for a copy of a birth record. It collects birth details, the requested number of copies, the purpose, and applicant information.
Who fills out the birth record copy application?: The person requesting the record completes the application. It asks for their relationship to the person whose record is requested and provides an option for an attorney to identify a client.
Do I need a notary for the birth record copy application?: No. This application is signed and dated without a notary, and it identifies no notarized or sworn attachment.
How do I submit the birth record copy application?: Submit it to the city department named on the form; check the city website for current contact details.

Need something notarized?

This Application to Local Registrar for Copy of Birth Record doesn’t need a notary — but if you have another Westfield form that does, a commissioned online notary can help.