Application For Record Of Birth - Town Of New Hartford (Page 2 of 2) in pdf

Application For Record Of Birth - Town Of New Hartford Page 2

PLEASE READ ALL INSTRUCTIONS BEFORE COMPLETING

THE APPLICATION ON THE REVERSE SIDE OF THIS FORM

A SELFADDRESSED, STAMPED ENVELOPE MUST BE FURNISHED

IN ORDER TO PROCESS AND FORWARD THE REQUESTED RECORD

Applicant Name

Address

City

State

Zip

FEE/MANNER OF PAYMENT

Fee: $10.00 per copy

Money orders and cashier checks made

Payable to the TOWN OF NEW HARTFORD.

Personal checks will NOT be accepted unless CERTIFIED

I.D. REQUIRED

All persons requesting a birth record MUST complete the attached application.

In accordance with State rules and regulations, ALL applicants must provide the original (o photocopy if

applying by mail) of ONE (1) of the following documents as proof of who they are:

current photo Driver’s license (showing physical address – no PO Boxes)

current photo NonDriver’s license (showing physical address – no PO Boxes)

current Military identification card

current Passport

Naturalization papers (NOTE: DO NOT PHOTOCOPY – IT IS A FEDERAL CRIME TO

PHOTOCOPY THIS DOCUMANT. THE ORIGINAL MUST BE PRESENTED)

current employer’s photo identification card (must contain employee’s name, date of birth,

signature and evidence that the I.D. card is current)

two (2) current and different utility bills issued and showing the applicant’s name and address,

together with the cancelled checks for payment of the bills or the bills stamped “paid”

NO OTHER DOCUMENTS WILL BE ACCEPTED AS IDENTITY.

Application For Record Of Birth - Town Of New Hartford Page 2