Application For Copy Of Birth Certificate - Cold Spring, Ny
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1Application 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:
(mm/dd/yy)
First
Middle
Last
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)
First
Middle
Last
__________________________
Father (as listed on birth certificate):
Number of Copies Requested:
__________________________
First
Middle
Last
Purpose for which Record is required:
Passport
Employment
Drivers License
Veteran’s Benefits
Social Security
Working Papers
Marriage License
Court Proceeding
Retirement
School Entrance
Welfare Assistance Entrance in Armed
Forces
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:
____________________________________________________________
Date: __________________________
Address of Applicant (please print):
Please Print or Type the name and
address where your record should be sent:
______________________________________________
(Name)
_________________________________
(Name)
______________________________________________
(address)
________________________________
(address)
______________________________________________
(city)
(state)
(zip)
________________________________
(city)
(state)
(zip)
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