Mail-in Application for Copy of Birth Certificate - New York

Information Page  Mail-in Application for Copy of Birth Certificate
General Instructions
Do not use this application to submit your request by fax.
 Use this application only if you are the person named on the birth certificate or that persons parents.
Use this application only if the birth occurred in New York State outside of New York City. Do not use this
application if the birth occurred in any of the five (5) boroughs of New York City.
Do not use this application for genealogy requests.
 Print a copy of this application, complete and sign.
Mail application along with check or money order and a copy of the required documentation (see below).
For regular handling send by first class mail, registered
mail, certified mail or U.S. Priority Mail to:
Certification Unit
Vital Records Section
New York State Department of Health
P.O. Box 2602
Albany, NY 12220-2602
Certification Unit
Vital Records Section / 2nd Floor
New York State Department of Health
800 North Pearl Street
Menands, NY 12204
Identification Requirements: Application must be submitted with copies of either A or B:
A. One (1) of the following forms of valid photo-ID:
 Driver license
 Non-driver license
 Passport
Other government issued photo-ID
B. Two (2) of the following showing the applicants name and address:
Utility bill or telephone bill
Letter from a government agency dated within the last six (6) months
Fees: If no record is on file, a No Record Certification is issued and the fee is not refunded.
For regular handling: The fee is $30.00 per copy.  Total for one (1) copy is $30.00. Total for two (2) copies is
$60.00, etc.
For priority handling: The fee is $30.00 + $15.00 per copy.  Total for one (1) copy is $45.00. Total for two (2)
copies is $90.00, etc. Submitting the application by overnight carrier is recommended. Completed requests will be
returned by first class mail unless a pre-paid return mailer for overnight delivery is provided with the request.
Send check or money order payable to the New York State Department of Health. Do not send cash.
Note:
Payment submitted from foreign countries must be made by a check drawn on a United States bank or by
international money order. Do not send cash.
Processing Time
Completing the Form
If you are using Adobe Reader 5.0 or newer (available as a free download from www.adobe.com) you can fill in the
form directly in Adobe Reader by clicking on the appropriate space and entering the information (use the TAB key to
move to the next field, shift-TAB to move backwards). Print the completed form, sign and mail to the above address.
®
You can print out a blank copy of the form and then type or print the required information.
Be sure to sign the form before mailing and include a check or money order made payable to the New York State
Department of Health along with copies of the required identification.
DOH-4380 (12/05) Page 1 of 2
Note: Copy of Passport required if request is made from a foreign country that requires a U.S. Passport for travel.
For the latest information on processing times, please visit our web page at
www.nyhealth.gov/vital_records/processingtime.htm
For faster processing, you may wish to use your credit card and submit your request by e-mail, fax, or telephone.
For priority handling (add $15.00 per copy ordered),
submission by overnight carrier is recommended. Send to:
Mail-in Application for Copy of Birth Certificate
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Page 1/2
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Mail-in Application for Copy of Birth Certificate - New York PDF

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