Philadelphia, NY · Jefferson County
Application for Copy of Birth Record
This application requests a copy of a birth record from the local registrar and is completed by the person seeking the record.
What this form is
Use this New York State Department of Health application to request a copy of a birth record from the local registrar. It asks for the person’s name and date of birth, birth location, parents’ names, number of copies, reason for the request, relationship to the person, and applicant contact information. Include the required identification copies with the application.
Who needs it
Anyone requesting a copy of a birth record should complete this application and provide the identification copies listed on the form.
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 requires copies of identification, but does not say they must be notarized.
How to submit this form
- 1
Download The Application
Download the birth record application PDF.
- 2
Complete The Application
Enter the requested birth, parent, applicant, and contact information, and select a reason for the request.
- 3
Gather Identification
Attach copies of either one listed valid photo ID or two listed documents showing your name and address.
- 4
Submit The Application
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the birth record application?
- No. The application is signed and dated without a notary. It requires copies of identification, but does not say they must be notarized.
- How do I submit the birth record 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 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 birth and parent details, the number of copies requested, the reason for the request, your relationship to the person, and your contact information.