Form Lb-296a-M - Application To Local Registrar For Copy Of Birth Record By Mail - City Of Long Beach Page 2

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BE SURE YOUR APPLICATION INCLUDES THE FOLLOWING:
• A completed application form, including a notarized signature.
Incomplete applications will be rejected!
• A clear copy of your valid driver’s license or non-driver’s ID.
Expired licenses are not accepted.
• A check or money order for $10.00 per copy requested made payable to
“CITY OF LONG BEACH”
• A self addressed, stamped envelope.
PLEASE NOTE:
• If paying by check, applications will be held seven (7) business days.
• If record is not found, a $10.00 search fee will apply.
SEND YOUR COMPLETED APPLICATION TO:
CITY OF LONG BEACH
ATTN: CITY CLERK – BIRTH RECORDS
1 WEST CHESTER STREET
LONG BEACH, NY 11561
QUESTIONS?
By phone: (516) 431-1002
On the web:

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