Walworth, NY · Wayne County
Application to Local Registrar for Copy of Birth Record
This application is for someone requesting a copy of a birth record from a Local Registrar for a listed purpose.
What this form is
Use this application to request a copy of a birth record from a Local Registrar. The form asks for the person’s name, date and place of birth, parents’ names, number of copies, and the purpose for the record. It also asks for the applicant’s relationship to that person, contact information, address, signature, and date.
Who needs it
A person requesting a birth record copy from a Local Registrar for one of the purposes listed on the application needs this form.
How to submit it
Submit the completed application to the Local Registrar; the form does not provide an address or other submission instructions.
About notarization
This application is signed and dated without a notary; the form does not identify any notarized attachment or related step.
How to submit this form
- 1
Download the Application
Download the Application to Local Registrar for Copy of Birth Record.
- 2
Complete the Applicant and Birth Details
Fill in the requested birth, parent, applicant, contact, and address information.
- 3
Select the Purpose and Number of Copies
Indicate the purpose for the record and enter the number of copies requested.
- 4
Sign and Date the Application
Sign and date the application, then submit it to the Local Registrar.
Frequently asked questions
- What is the Application to Local Registrar for Copy of Birth Record?
- It is an application to request a copy of a birth record from a Local Registrar. It asks for birth details, the requested number of copies, and the reason for the request.
- Who fills out this birth record application?
- The applicant provides their relationship to the person whose record is requested, along with contact information, address, signature, and date.
- Do I need a notary for the Application to Local Registrar for Copy of Birth Record?
- No. The application is signed and dated without a notary, and the form does not identify a notarized attachment or related step.
- How do I submit the birth record application?
- Submit the completed application to the Local Registrar. The form does not provide an address or other submission instructions.
Need something notarized?
This Application to Local Registrar for Copy of Birth Record doesn’t need a notary — but if you have another Walworth form that does, a commissioned online notary can help.