Form Doh-4382 - Mail-In Application For Copy Of Marriage Certificate

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NEW YORK STATE DEPARTMENT OF HEALTH
Mail-in Application for Copy of Marriage Certificate
Vital Records Section
Information Page
Mail-in Application for Copy of Marriage Certificate
General Instructions
Do not use this application to submit your request by fax.
Use this application if you are the bride or groom named on the marriage certificate.
If you are not the bride or groom named on the marriage certificate, then you must submit with this application a copy of
documentation establishing a judicial or other proper purpose (see below).
Use this application only if the marriage license was obtained in New York State outside of New York City. Do not use this
application if the marriage license was obtained in any of the five (5) boroughs of New York City.
Do not use this application for genealogy requests.
If delivery is to a P.O. Box or to a third party you must submit, with this application, a notarized statement signed by the bride
or groom and a copy of the bride or grooms drivers license.
Print a copy of this application, complete and sign.
Mail application with check or money order and a copy of any required documentation (see below).
For regular handling send by first class mail, registered
For priority handling (add $15.00 per copy ordered),
mail, certified mail or U.S. Priority Mail to:
submission by overnight carrier is recommended. Send to:
Certification Unit
Certification Unit
Vital Records Section
Vital Records Section / 2nd Floor
New York State Department of Health
New York State Department of Health
P.O. Box 2602
800 North Pearl Street
Albany, NY 12220-2602
Menands, NY 12204
What is a judicial or other proper purpose?
If the applicant is not the bride or groom, a judicial or other proper purpose must be documented. An example of a judicial or
other proper purpose would be a marriage record needed by the applicant to claim a benefit.
Documentation would consist of a copy of a court order or an official letter verifying that a copy of the requested marriage
record is required from the applicant in order to process a claim.
Identification Requirements -- Application must be submitted with copies of either A or B:
Note: Copy of Passport required if request is made from a foreign country that requires a U.S. Passport for travel.
One (1) of the following forms of valid photo-ID:
A.
Driver license
Non-Driver Photo-ID Card
Passport
Other government issued photo-ID
Two (2) of the following showing the applicants name and address:
B.
Utility or telephone bills
Letter from a government agency dated within the last six months
Fees: If no record is on file, a No Record Certification is issued and the fee is not refunded.
For regular handling: The fee is $30.00 per copy.
Total for one (1) copy is $30.00. Total for two (2) copies is $60.00, etc.
For priority handling: The fee is $30.00 + $15.00 per copy
Total for one (1) copy is $45.00. Total for two (2) copies is
$90.00, etc. Submitting the application by overnight carrier is recommended. Completed requests will be returned by first class
mail unless a pre-paid return mailer for overnight delivery is provided with the request.
Send check or money order payable to the New York State Department of Health. Do not send cash.
Note: Payment submitted from foreign countries must be made by a check drawn on a United States bank or by international
money order. Do not send cash.
Processing Time
For the latest information on processing times, please visit our web page at
For faster processing, you may wish to use your credit card and submit your request by e-mail, fax, or telephone.
Completing the Form
®
5.0 or newer (available as a free download from ) you can fill in the form
If you are using Adobe Reader
directly in Adobe Reader by clicking on the appropriate space and entering the information (use the TAB key to move to the
next field, shift-TAB to move backwards). Print the completed form, sign and mail to the above address.
You can print out a blank copy of the form and then type or print the required information.
Be sure to sign the form before mailing and include a check or money order made payable to the New York State Department of
Health along with any required documentation.
DOH-4382 (12/05) Page 1 of 2

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