Jefferson County, NY · Jefferson County
Notification of Appointment of Registrar of Vital Statistics
This form records the appointment or reappointment of a registrar and deputy registrar of vital statistics for a county or locality.
At a glance
- Issued by
- City of Jefferson County · Jefferson County, Jefferson County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- jeffersoncountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The notification records a new appointment or reappointment, including the registrar’s and deputy registrar’s details, appointment information, and appointing officer’s signature. It also contains affidavits for both officers. The instructions say to complete the notice and oath in triplicate immediately after the registrar’s appointment, file the original with the New York State Department of Health, file one copy with the County Clerk, and retain one copy.
Who needs it
An appointing officer completes the notice for a new or reappointed registrar and deputy registrar of vital statistics.
How to submit it
Execute the notice and oath in triplicate immediately after appointment. File the original with the New York State Department of Health, Vital Records Registration Unit, one copy with the County Clerk, and retain one copy.
About notarization
This document is signed without a notary; the signer just signs and dates it.
How to submit this form
- 1
Download the Form
Download the Notification of Appointment of Registrar of Vital Statistics.
- 2
Complete the Appointment Details
Fill in the registrar and deputy registrar information, appointment details, and appointing officer information.
- 3
Prepare Three Copies
Execute the notice and oath in triplicate immediately after the registrar’s appointment.
- 4
File and Retain Copies
File the original with the New York State Department of Health, one copy with the County Clerk, and keep one copy for your records.
Frequently asked questions
- Do I need a notary for the Registrar Appointment Notice?
- No. This document is signed without a notary; the signer just signs and dates it.
- How do I submit the Registrar Appointment Notice?
- Execute the notice and oath in triplicate immediately after appointment. Send the original to the New York State Department of Health, file one copy with the County Clerk, and retain one copy.
- When should the appointment notice be completed?
- The instructions say the notice and oath shall be executed in triplicate immediately after the registrar’s appointment.