Form Doh-4380 - Mail-In Application For Copy Of Birth Certificate printable pdf download

NEW YORK STATE DEPARTMENT OF HEALTH

Mail-in Application for Copy of Birth Certificate

Vital Records Section

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 persons 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

For priority handling (add $15.00 per copy ordered),

mail, certified mail or U.S. Priority Mail to:

submission by overnight carrier is recommended. Send to:

Certification Unit

Vital Records Section

Vital Records Section / 2nd Floor

New York State Department of Health

P.O. Box 2602

800 North Pearl Street

Albany, NY 12220-2602

Menands, NY 12204

Identification Requirements: Application must be submitted with copies of either A or B:

Note: Copy of Passport required if request is made from a foreign country that requires a U.S. Passport for travel.

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

For the latest information on processing times, please visit our web page at

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For faster processing, you may wish to use your credit card and submit your request by e-mail, fax, or telephone.

Completing the Form

If you are using Adobe Reader 5.0 or newer (available as a free download from ) 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

Form Doh-4380 - Mail-In Application For Copy Of Birth Certificate

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