Form Doh-4380 - Application To Local Registrar For Copy Of Birth Certificate
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2Application to Local Registrar for Copy of Birth Certificate
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Information Page - Mail-in Application for Copy of Birth Certificate
General Instructions
• Do not use this application to submit your request by fax.
• Use this application only if you are the person named on the birth certificate or that person's parents.
• Use this application only if the birth occurred in New York State outside of New York City. Do not
use this application if the birth occurred in any of the five (5) boroughs of New York City.
• Do not use this application for genealogy requests.
• Print a copy of this application, complete and sign.
• Mail application along with check or money order and a copy of the required documentation (see below).
For regular handling send by first class mail, registered
mail, certified mail or U.S. Priority Mail to:
Tompkins County Health Department
Vital Records Section
55 Brown Road
Ithaca, NY 14850
Identification Requirements: Application must be submitted with acceptable identification:
Note: Copy of Passport required if request is made from a foreign country that requires a U.S. Passport for travel.
A. One (1) of the following forms of valid photo-ID:
• Driver license
• Non-driver license
• Passport
• Naturalization Papers
• Military ID
• Employer’s Photo ID
• Police report of lost or stolen ID
B. Two (2) of the following showing the applicant's name and address:
• Utility bill or telephone bill
• Letter from a government agency dated within the last six (6) months
Fee per transaction:*
• $30 for the first certified copy, $15 for each additional copy
*One transaction refers to one customer ordering a single record at any one time.
DOH-4380 (12/05) Page 1 of 2
TCHD (10/14) (12/16)
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Parent category: Legal