Gouverneur, NY · St. Lawrence County
Application for Copy of Birth Record
This application requests a copy of a birth record from the local registrar for a birth that occurred in Gouverneur.
What this form is
Use this New York State Department of Health application to request a copy of a birth record for someone born in Gouverneur. It asks for information about the birth, the applicant’s relationship to the person named on the record, the purpose of the request, and the applicant’s signature and date. It also requires identification copies; requests from someone other than the child or named parents require notarized authorization.
Who needs it
A person requesting a birth record for a Gouverneur birth needs this application and must provide the identification copies specified on the form.
How to submit it
Submit it to the local registrar; check the city website for current contact details. The form lists $10.00 per certified copy or No Record Certification.
About notarization
The applicant signs and dates this form without a notary; a request from someone other than the child or named parents requires notarized authorization.
How to submit this form
- 1
Download The Application
Download the application for a copy of a birth record.
- 2
Complete The Application
Provide the requested birth details, your relationship to the person named on the record, the request purpose, and your signature and date.
- 3
Gather Identification
Attach copies of either one listed form of valid photo ID or two listed items showing your name and address.
- 4
Submit To The Local Registrar
Submit the application to the local registrar; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Birth Record Copy Application?
- No. The applicant signs and dates this form without a notary. However, a request from someone other than the child or named parents requires notarized authorization.
- How do I submit the Birth Record Copy Application?
- Submit the application to the local registrar. The form does not give an address or other contact details, so check the city website for current information.
- What identification must I provide?
- Submit copies of either one listed form of valid photo ID or two listed items showing your name and address, such as utility or telephone bills or a government-agency letter dated within the last six months.
Need something notarized?
This Application for Copy of Birth Record doesn’t need a notary — but if you have another Gouverneur form that does, a commissioned online notary can help.