Form Doh-1562 - General Information And Application For Genealogical Services
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2NEW YORK STATE DEPARTMENT OF HEALTH
General Information and Application
Vital Records Section, Genealogy Unit
Empire State Plaza
For Genealogical Services
Albany, New York 12237-0023
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE $11.00 includes search and uncertified copy or notification of no record.
2. Original records of births and marriages for the entire state begin with 1881; deaths begin with 1880, EXCEPT for records
filed in Albany, Buffalo and Yonkers prior to 1914. Applications for these cities should be made directly to the local office.
3. The New York State Department of Health does not have New York City records except for births occurring in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the Administrative Rule Summary on the reverse side of this sheet, which specifies years available for
genealogical research.
To insure a complete search, provide as much information as possible. Please complete for tvDe of record
requested, birth, death OR marriage.
Name at Birth ____________________________________
Name at Birth ____________________________________
Date of Birth _____________________________________
Date of Birth _____________________________________
Place of Birth ____________________________________
Place of Birth ____________________________________
Father’ s Name ___________________________________
Father’ s Name ___________________________________
Mother’ s Maiden Name ____________________________
Mother’ s Maiden Name ____________________________
Name of Bride ___________________________________
Name of Bride ___________________________________
Name of Groom __________________________________
Name of Groom __________________________________
Date of Marriage _________________________________
Date of Marriage _________________________________
Place of Marriage
Place of Marriage
And/or License __________________________________
And/or License __________________________________
Name at Death ___________________________________
Name at Death ___________________________________
Date of Death _______________ Age a Death __________
Date of Death _______________ Age a Death __________
Place of Death ___________________________________
Place of Death ___________________________________
Names of Parents ________________________________
Names of Parents ________________________________
Name of Spouse _________________________________
Name of Spouse _________________________________
For what purpose is information required? _______________________________________________________________
What is your relationship to person whose record is requested? ______________________________________________
In what capacity are you acting? ______________________________________________________________________
SIGNATURE OF APPLICANT _________________________________________________ DATE _________________
Send record to: (please print)
If requesting birth and marriage records, please sign the following
ADDRESS _______________________________________________________________________________________
Health Commissioner’ s
statement:
Name ___________________________________________
To the best of my knowledge, the person(s) named in the
Address _________________________________________
application are deceased.
Administrative Rules and Regulations
City __________________ State _______ Zip Code ______
____________________________________________________
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