Vital Record Request Form - Town Clerk'S Office, Bridgton, Maine

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Town Clerk’s Office, 3 Chase Street, Suite 1, Bridgton, Maine 04009 ▪ 207-647-8786
Laurie L. Chadbourne, Town Clerk
checks payable to: Town of Bridgton
Birth Certificate
Death Certificate
Marriage Certificate
Name on birth record:
Full Name of Decedent:
Full Maiden Name of Bride:
_______________________________________
_______________________________________
_______________________________________
Date of Birth: ___________________________
Date of Death: ___________________________
Full Name of Groom:
How many copies? ______________________
How many copies? _______________________
_______________________________________
Parents Names (with mother’s maiden):
Applicant Name:
Date of Marriage: ________________________
_______________________________________
_______________________________________
How many copies? ______________________
_______________________________________
Applicant Address & Phone #:
Applicant Name:
Applicant Name:
_______________________________________
_______________________________________
_______________________________________
_______________________________________
Applicant Address & Phone #:
Applicant Address & Phone #:
Indicate your Relationship to the person on
_______________________________________
requested record below:
_______________________________________
_______________________________________
 Spouse
_______________________________________
Indicate your Relationship to the person on
 Registered Domestic Partner
requested record below:
Indicate your Relationship to the person on
 Parent
requested record below:
 Self/Spouse
 Self
 Guardian
 Parent
 Spouse
 Descendant
 Guardian
 Registered Domestic Partner
 Family _______________________
 Descendant
 Parent
 Funeral Director
 Attorney of person on record
 Guardian
 Attorney of person on record
 Family _______________________
 Descendant
 Genealogist ID # _______________
 Genealogist ID # _______________
 Attorney or Agent of person on record
 None of the above (short form will
 Family _______________________
be issued)
 Genealogist ID # _______________
By signing below, I swear/affirm that the information above is true
By signing below, I swear/affirm that the information above is true
By signing below, I swear/affirm that the information above is true
and correct.
and correct.
and correct.
Applicant Signature:
Applicant Signature:
Applicant Signature:
___________________________________
___________________________________
___________________________________
Today’s Date: _______________________
Today’s Date: _______________________
Today’s Date: _______________________
st
$15 for 1
copy, $6 for each additional copy
st
st
$15 for 1
copy, $6 for each additional copy
$15 for 1
copy, $6 for each additional copy

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