Marion, NY · Wayne County
Birth Certificate Application
This application is used by a person requesting a copy of a birth record from a local registrar and identifies the record and reason for the request.
What this form is
Use this New York State Department of Health application when requesting 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, reason for the request, applicant's relationship, contact and address information, and signature and date.
Who needs it
Anyone requesting a copy of a birth record from a local registrar can use this application to provide record and applicant 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 document is signed without a notary; the applicant just signs and dates the application.
How to submit this form
- 1
Download The Application
Download the Birth Certificate Application PDF.
- 2
Complete The Form
Enter the birth record details, requested number of copies, reason for the request, relationship, and applicant information.
- 3
Review Supporting Materials
The provided document does not list any attachments; check with the city department if you have questions about supporting materials.
- 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 Certificate Application?
- No. The applicant signs and dates this application; it contains no notary block.
- How do I submit the Birth Certificate Application?
- The document identifies the application as being for a local registrar but does not provide submission contact 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 requested, the reason for the request, the applicant's relationship to the person, and applicant contact and address information.