Application To Local Registrar For Copy Of Birth Record - Canandaigua, Ny
ADVERTISEMENT
1NEW YORK STATE DEPARTMENT OF HEALTH
Application to Local Registrar for Copy of Birth Record
Vital Records Section
Certificate Information
THIS OFFICE ONLY HANDLES BIRTH CERTIFICATES FOR THOSE BORN IN THE CITY OF CANANDAIGUA. BIRTH RECORDS ARE NOT
PUBLIC INFORMATION
Name: (as listed on birth certificate)
Date of Birth: (mm/dd/yyyy)
First:
Middle:
Last:
Maiden Name of Mother: (as listed on Birth Certificate)
First:
Middle:
Maiden Last:
Father: (as listed on Birth Certificate)
Numer of Copies Requested:
First:
Middle:
Last:
Welfare Assistance
Passport
Working Papers
Social Security-Retirement
School Entrance
Veteran's Benefits
Purpose for Which Record is
Driver's License
Court Proceeding
Social Security- SSI
Required (Check One)
Retirement
Entrance into Armed Forces
Marriage License
Other (Specify) _____________________________________________
Applicant Information
DO NOT WRITE IN SPACE BELOW
What is your relationship to person whose record is requested:
Type of ID:
Self
Parent
Other: (specify) ____________
Drivers License
Name of Applicant: (Please Print)
State: ______
No.:______________________
Signature of Applicant:
Other ID (Specify)
__________________________
__________________________
Date Signed:
Address of Applicant: (Street, City, State, Zip)
Certificate Number: _________________
Telephone Number:
TYPES OF ACCEPTABLE IDENTIFICATION:
1. Driver's License 2. Non-driver's License 3. Passport
4. Naturalization Papers 5. Military ID 6. Employer's Photo ID 7. Two Utility Bills, showing applicant's name and address
8. Police report of lost or stolen ID
If in person, please bring a form of acceptable identification and payment of $10.00 (cash, check, or money order). Make checks
payable to City of Canandaigua.
If by mail, please enclose with this form a copy of acceptable identification and payment of $15.00, money order only . Make
money orders payable to City of Canandaigua.
Mail to:
City of Canandaigua
2 North Main Street
Canandaigua, NY 14424
Revised: 6/2011
F:CLERKFORMS 1 Birth RecordsApplication for Copy of Birth Record (WEB-Master)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application To Local Registrar For Copy Of Birth Record Form - New York State Department Of Health
Legal
Form Lb-296a-m - Application To Local Registrar For Copy Of Birth Record By Mail - City Of Long Beach
Business
Related Categories
Parent category: Business