Application for Copy of Birth Certificate
The Fee is $10 per copy. Make Check or Money Order payable to Village of Cold Spring.
Required ID must be included with the application.
Please send all applications or bring in person to:
Village of Cold Spring
(845) 265-3611 - phone
85 Main St.
(845) 265-1002 - Fax
Cold Spring NY 10516
Applications may be mailed or brought to above address. Please do not mail cash.
Name (as listed on Birth Certificate):
Date of Birth:
Village where birth occurred:
Name of Hospital where birth occurred:
Maiden Name of Mother (as listed on birth certificate)
Birth Certificate No. (if known)
Local Registration No. (if known)
Father (as listed on birth certificate):
Number of Copies Requested:
Purpose for which Record is required:
Welfare Assistance Entrance in Armed
Other (specify): __________________________________________________________________
What is your relationship to person
If attorney, give name and relationship of your client to
whose record is required?
person whose record is required:
Signature of Applicant:
Address of Applicant (please print):
Please Print or Type the name and
address where your record should be sent: