Keene, NY · Essex County
Application for Birth Record
The Town of Keene application for requesting a birth record asks for information about the person named on the record and the requester.
What this form is
Use this application to request a birth record from the Town of Keene. It asks for the person’s name, birth date and place, parents’ names, and the requester’s contact details, relationship, purpose, and number of copies. The form lists identification requirements and a $10 fee for each certified copy, and asks applicants to enclose a self-addressed stamped envelope.
Who needs it
A person requesting a birth record from the Town of Keene completes this application and provides the identification required for their situation.
How to submit it
Mail it to Town of Keene, PO Box 245, Keene, NY 12942; include $10 for each certified copy, payable to Town of Keene, and a self-addressed stamped envelope.
About notarization
This application is signed without a notary; applicants using an authorized representative must also enclose a notarized letter authorizing release.
How to submit this form
- 1
Download The Application
Download the Town of Keene Application for Birth Record PDF.
- 2
Complete The Form
Print clearly and provide the requested birth record and requester information.
- 3
Gather Required Items
Include the identification required for your request, the $10 fee for each certified copy, and a self-addressed stamped envelope.
- 4
Mail The Application
Send the application and included items to Town of Keene, PO Box 245, Keene, NY 12942.
Frequently asked questions
- Do I need a notary for the Keene birth record application?
- No. The application is signed without a notary. If someone requests the record on your behalf, the form requires a notarized letter authorizing its release.
- How do I submit the Keene birth record application?
- Mail the application to Town of Keene, PO Box 245, Keene, NY 12942. Include $10 for each certified copy, payable to the Town of Keene, and a self-addressed stamped envelope.
- What information does the application request?
- It asks for the person’s name, date and place of birth, parents’ names, and the requester’s signature, contact information, relationship, purpose, and number of copies.
- What identification is required?
- The form lists valid photo ID, or valid photo ID together with proof of relationship and a notarized authorization letter, depending on the request.
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.