West Haverstraw, NY · Rockland County
Application for Birth Certificate
This application is for someone requesting a birth certificate record from the local registrar and provides space for the applicant’s details and reason for the request.
What this form is
The application requests a birth certificate record and asks for the person's name, date and place of birth, parents’ names, and number of copies requested. It also asks the applicant to select a purpose for the record, state their relationship to the person, and provide contact information, a signature, and an address. The form does not state when the city requires it.
Who needs it
A person requesting a birth certificate record who can provide the details requested on the application should use this 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 document is signed without a notary; the form asks the applicant to sign and date it, and does not mention a notarized or sworn attachment.
How to submit this form
- 1
Download the Application
Download the birth certificate application PDF.
- 2
Complete the Form
Enter the requested birth details, purpose, applicant relationship, contact information, and address.
- 3
Sign and Date
Sign and date the application.
- 4
Submit to the City
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 certificate application?
- No. The form asks the applicant to sign and date it, and does not mention a notarized or sworn attachment.
- How do I submit the birth certificate application?
- Submit it to the city department named on the form; check the city website for current contact details.
- What information does the application ask for?
- It asks for the person's name, birth date and place, parents’ names, number of copies, purpose for the record, the applicant’s relationship, contact information, signature, and address.
Need something notarized?
This Application for Birth Certificate doesn’t need a notary — but if you have another West Haverstraw form that does, a commissioned online notary can help.