What information does the birth record application ask for?

It asks for the person's name, date and place of birth, parents' names, number of copies, purpose for the record, applicant relationship and contact information, and signature.

Who can use this birth record application?

A person requesting a copy of a birth record can use the application to provide the details requested by the Local Registrar.

Do I need a notary for the birth record application?

No. This document is signed and dated without a notary, and it lists no notarized attachment or sworn step.

How do I submit the birth record application?

The form identifies the Local Registrar. Submit it to the city department named on the form and check the city website for current contact details.

Black Brook, NY · Clinton County

No notary required

Application for Copy of Birth Record

This application lets a person request a copy of a birth record from the Local Registrar by providing birth details, applicant information, and the purpose for the record.

What this form is

Use this application to request a copy of a birth record from the Local Registrar. It asks for the person's name, date and place of birth, parents' names, number of copies requested, purpose for the record, applicant's relationship to the person, and the applicant's contact information and signature.

Who needs it

Anyone requesting a copy of a birth record can use this application to provide the information requested by the Local Registrar.

How to submit it

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

About notarization

This document is signed and dated without a notary; it lists no notarized attachment or sworn step.

How to submit this form

1
Download The Application
Download the birth record copy application.
2
Complete The Application
Fill in the birth details, purpose for the record, applicant relationship, and contact information requested.
3
Sign And Date
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 information does the birth record application ask for?: It asks for the person's name, date and place of birth, parents' names, number of copies, purpose for the record, applicant relationship and contact information, and signature.
Who can use this birth record application?: A person requesting a copy of a birth record can use the application to provide the details requested by the Local Registrar.
Do I need a notary for the birth record application?: No. This document is signed and dated without a notary, and it lists no notarized attachment or sworn step.
How do I submit the birth record application?: The form identifies the Local Registrar. Submit it to the city department named on the form and check the city website for current contact details.

Need something notarized?

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