Pitcairn, NY · St. Lawrence County
Application for Copy of Birth Record
This application lets an eligible person request a copy of a birth record from a local registrar using the applicant’s relationship and purpose.
What this form is
Use this New York State Department of Health application to request a copy of a birth record from a local registrar. It asks for the person’s name, date and place of birth, parents’ names, number of copies, and the purpose for the request. The applicant also provides their relationship to the person, telephone number, Social Security number, address, and signature.
Who needs it
A person requesting a copy of a birth record from a local registrar uses this application to provide the required identifying and request details.
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 without a notary; the applicant just signs and dates it, and the form does not list a notarized attachment.
How to submit this form
- 1
Download The Application
Download the birth record copy application PDF.
- 2
Complete The Application
Enter the birth details, requested copy count, purpose, relationship, and applicant information.
- 3
Sign And Date
Sign and date the application; the form does not list a notarized attachment.
- 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 record copy application?
- No. The application has a signature and date field but no notary block or notarized attachment; the applicant signs and dates it.
- How do I submit the birth record copy application?
- The document does not provide submission details. 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 birth details, parents’ names, the number of copies and purpose, the applicant’s relationship to the person, and applicant contact and signature details.
Need something notarized?
This Application for Copy of Birth Record doesn’t need a notary — but if you have another Pitcairn form that does, a commissioned online notary can help.