Vital Record Request Form - Town Clerk'S Office, Bridgton, Maine Page 2
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2------------------------------------------------------- This side to be completed by office personnel -------------------------------------------------------
# of Copies Issued: ______ Cost: $______ Clerk’s Initials: ______
# of Copies Issued: ______ Cost: $______ Clerk’s Initials: ______
# of Copies Issued: ______ Cost: $______ Clerk’s Initials: ______
Birth Certificate
Marriage Certificate
Death Certificate
Proof of identity of applicant:
Proof of identity of applicant:
Proof of identity of applicant:
Applicant must provide one of these:
Applicant must provide one of these:
Applicant must provide one of these:
Driver’s License
Driver’s License
Driver’s License
Passport
Passport
Passport
Government issued picture I.D.
Government issued picture I.D.
Government issued picture I.D.
OR two of these:
OR two of these:
OR two of these:
Utility bills
Utility bills
Utility bills
Bank statements
Bank statements
Bank statements
Vehicle registration
Vehicle registration
Vehicle registration
Income tax return
Income tax return
Income tax return
Personal Check w/ address
Personal Check w/ address
Personal Check w/ address
A previously issued vital record
A previously issued vital record
A previously issued vital record
Letter from government agency requesting record
Letter from government agency requesting record
Letter from government agency requesting record
(DHHS, WIC)
(DHHS, WIC)
(DHHS, WIC)
Department of Corrections I.D. card
Department of Corrections I.D. card
Department of Corrections I.D. card
Social Security Card
Social Security Card
Social Security Card
DD 214
DD 214
DD 214
Hospital; birth worksheet
Hospital; birth worksheet
Hospital; birth worksheet
License/rental agreement
License/rental agreement
License/rental agreement
Pay stub
Pay stub
Pay stub
W-2
W-2
W-2
Voter Registration card
Voter Registration card
Voter Registration card
Disability award from SSA
Disability award from SSA
Disability award from SSA
Other ________________
Other ________________
Other _________________
Establishing eligibility to acquire record:
Establishing eligibility to acquire record:
Establishing eligibility to acquire record:
Related applicants must provide proof of lineage
Related applicants must provide proof of lineage
Related applicants must provide proof of lineage
Domestic Partners must provide proof of
Domestic Partners must provide proof of
Domestic Partners must provide proof of
registration of domestic partnership
registration of domestic partnership
registration of domestic partnership
Attorneys must provide a signed, notarized
Attorneys must provide a signed, notarized
Attorneys must provide a signed, notarized
release from family
release from family
release from family
Genealogists must provide a state-issued card
Genealogists must provide a state-issued card
Genealogists must provide a state-issued card
Do not retain copies of proof provided or note any specific numbers
Do not retain copies of proof provided or note any specific numbers
Do not retain copies of proof provided or note any specific numbers
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