City of Watertown, New York - Application to Local Registrar for Copy of Birth Record

City of Watertown New York

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Application to Local Registrar for Copy of Birth Record

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A New York State Department of Health form used to request a certified copy of a birth record from the local registrar.

Certificate Information

*Name of person on certificate

First, Middle, Last

*Date of Birth

MM/DD/YYYY

Place of Birth – Hospital

If not a hospital, give street and number

Place of Birth – Village, Town or City

Place of Birth – County

Father's name

First, Middle, Last

Mother's maiden name

First, Middle, Last

*Number of Copies Requested

Birth Number (if known)

Local Registration Number (if known)

*Purpose for Which Record is Required

Passport

Social Security – Retirement

Social Security – SSI

Retirement

Employment

Working Papers

School Entrance

Driver's License

Marriage License

Welfare Assistance

Veteran's Benefits

Court Proceeding

Entrance into Armed Forces

Other

Select all that apply

If purpose is Other, please specify

Applicant Information

*Applicant's name

First, Middle, Last

*What is your relationship to the person whose record is required?

Self

Parent

Other

If relationship is Other, please specify

*Telephone Number

Include area code

*Social Security Number

*Signature of Applicant

Type your full name to confirm:

*Address – Street

*Address – City

*Address – State

*Address – Zip Code

If you are an attorney, name of client whose record is required

If you are an attorney, relationship of client to person whose record is required

Acceptable Identification – Please note

You must present one of the following: (1) Driver's license, (2) Non-driver's license, (3) Passport, (4) Naturalization Papers, (5) Military ID, (6) Employer's Photo ID, (7) Two utility bills showing your name and address, or (8) Police report of lost or stolen ID. A copy will not be issued without acceptable identification.

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Contact Info

City of Watertown
City Hall
245 Washington St
Watertown, NY 13601

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