Nyack, NY · Rockland County
Application to Local Registrar for Copy of Birth Record
This application lets a person request a copy of a birth record from the local registrar and provide identification and applicant details.
At a glance
- Issued by
- City of Nyack · Nyack, Rockland County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- nyack.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this application to request a copy of a birth record from the local registrar. It asks for the subject’s name and birth details, the applicant’s relationship and contact information, the purpose and number of copies requested, and the applicant’s signature and date. The form lists fees by district and requires copies of specified identification; some requests also require notarized authorization.
Who needs it
A person requesting a copy of a birth record from the local registrar must complete this application and provide the required identification.
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; requests from anyone other than the named child or parents require separate notarized authorization.
How to submit this form
- 1
Download the Application
Download the birth record copy application.
- 2
Complete the Application
Enter the birth and applicant details, purpose, number of copies, and sign and date the form.
- 3
Gather Identification
Attach copies of one listed photo ID or two listed documents showing your name and address.
- 4
Submit to the City
Submit the application 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 copy application?
- No. Sign and date the application without a notary. If you are not the child or a parent named on the certificate, the form requires separate notarized authorization.
- How do I submit the birth record application?
- The form does not provide submission contact details. Submit it to the city department named on the form and check the city website for current contact details.
- What identification must I include?
- Include a copy of one listed valid photo ID, or copies of two listed items showing your name and address, such as utility bills or a recent government-agency letter.
- What fee does the form list?
- The form lists $30 for Monroe County and $10 per certified copy or No Record Certification for other districts.
Need something notarized?
This Application to Local Registrar for Copy of Birth Record doesn’t need a notary, but if you have another Nyack form that does, a commissioned online notary can help.