How do I submit the Application for Birth Record?

Mail it to the Town of Keene at 10892 NYS Route 9N, Keene, NY 12942. Include the fee, a self-addressed stamped envelope, and the required identification or authorization.

What information does the application ask for?

It asks for the record holder’s name, birth date and place, parents’ names, requester information, relationship, purpose, number of copies, and signature.

What does a certified copy cost?

The form states a fee of $10 for each certified copy. It says checks should be made payable to Town of Keene.

Keene, NY · Essex County

No notary required

Application for Birth Record

This application is for people requesting a birth record from the Town of Keene, including applicants seeking a certified copy.

What this form is

Use this application to request a birth record from the Town of Keene. It asks for details about the person named on the record, the requester’s identification, relationship and purpose, the number of copies, and a signature. The form lists a $10 fee for each certified copy and explains what identification or authorization to enclose.

Who needs it

Anyone requesting a birth record from the Town of Keene should complete the application and provide the identification or authorization listed on it.

How to submit it

Mail the application to the Town of Keene, 10892 NYS Route 9N, Keene, NY 12942. Enclose a check payable to Town of Keene, a self-addressed stamped envelope, and the required identification or other documents listed on the form.

About notarization

The application is signed without a notary; if someone else requests the record, the form calls for a notarized letter authorizing its release.

How to submit this form

1
Download The Application
Download the Town of Keene Application for Birth Record PDF.
2
Complete The Application
Print clearly and provide the requested birth record and requester details, purpose, number of copies, and signature.
3
Gather Required Items
Include valid photo ID and any proof of relationship or notarized authorization required for your request, plus a self-addressed stamped envelope and payment.
4
Mail The Application
Mail the completed application and enclosures to the Town of Keene, 10892 NYS Route 9N, Keene, NY 12942.

Frequently asked questions

Do I need a notary for the Application for Birth Record?: No. The application itself is signed without a notary. If someone else requests the record, the form calls for a notarized letter authorizing its release.
How do I submit the Application for Birth Record?: Mail it to the Town of Keene at 10892 NYS Route 9N, Keene, NY 12942. Include the fee, a self-addressed stamped envelope, and the required identification or authorization.
What information does the application ask for?: It asks for the record holder’s name, birth date and place, parents’ names, requester information, relationship, purpose, number of copies, and signature.
What does a certified copy cost?: The form states a fee of $10 for each certified copy. It says checks should be made payable to Town of Keene.

Need something notarized?

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