Rushville, NY · Yates County
Mail-In Application for Genealogical Services
This application lets people request genealogical birth, death, or marriage records from the New York State Department of Health by mail.
What this form is
Use this application to request genealogical birth, death, or marriage records from the New York State Department of Health. It is for genealogy requests, and record access depends on the record’s age and the applicant’s relationship to the person; direct-line descendants may provide documentation of descent. The form asks for details about the record, the applicant’s relationship and contact information, and a signature.
Who needs it
People seeking genealogical birth, death, or marriage records from the New York State Department of Health can use this application.
How to submit it
Mail the signed application to the Certification Unit, Vital Records Section, New York State Department of Health, P.O. Box 2602, Albany, NY 12220-2602, with a check or money order and copies of required documentation.
About notarization
This application is signed and dated without a notary; it does not require a notarized attachment or sworn statement.
How to submit this form
- 1
Download The Application
Download and print the Mail-In Application for Genealogical Services.
- 2
Complete The Form
Fill in the applicable birth, death, or marriage record details, your relationship to the person, and your contact information.
- 3
Gather Required Items
Include a check or money order and copies of any required documentation.
- 4
Sign And Mail
Sign and date the application, then mail it and the required items to the address printed on the form.
Frequently asked questions
- Do I need a notary for this application?
- No. The application asks you to sign and date it; it does not require a notary, notarized attachment, or sworn statement.
- How do I submit the genealogical services application?
- Mail the signed application to the address printed on the form with a check or money order and copies of any required documentation.
- What records can I request?
- The form is for genealogical birth, death, and marriage record requests from the New York State Department of Health.
- What information does the application ask for?
- It asks for details about the requested record, your relationship to the person, your contact information, and your signature.
Need something notarized?
This Mail-In Application for Genealogical Services doesn’t need a notary — but if you have another Rushville form that does, a commissioned online notary can help.