Philadelphia, NY · Jefferson County
Application for Copy of Birth Record
This application lets a person request copies of a birth record from a local registrar and provide identification and details about the record.
What this form is
Use this application to request copies of a birth record from a local registrar. It asks for the person’s name and birth details, the requested number of copies, the purpose and the applicant’s relationship to the person on the record. The application must be submitted with copies of the required identification: one listed photo ID or two listed documents showing the applicant’s name and address.
Who needs it
A person requesting a copy of a birth record should complete this application and include the required identification copies.
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; the form does not identify any attachment or related step that must be sworn or notarized.
How to submit this form
- 1
Download The Application
Download the Application for Copy of Birth Record PDF.
- 2
Complete The Application
Enter the birth record details, number of copies, purpose, relationship, and applicant information.
- 3
Gather Identification Copies
Include one listed valid photo ID or two listed documents showing the applicant’s name and address.
- 4
Sign And Submit
Sign and date the application, then submit it to the city department named on the form.
Frequently asked questions
- Do I need a notary for the birth record copy application?
- No. The application is signed and dated without a notary, and the form does not identify any attachment or related step that must be sworn or notarized.
- 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.
- What identification must I include?
- Include copies of either one listed form of valid photo ID or two listed documents showing the applicant’s name and address.
- What information does the application ask for?
- It asks for the record holder’s name and birth details, the requested number of copies, the purpose, the applicant’s relationship, and the applicant’s signature and contact information.