Fillable Apostille/Certificate of Authentication Request (New York State)

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Apostille/Certificate of Authentication Request (New York State)

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www.dos.ny.gov
New York State
Department of State
Division of Licensing Services
Apostille and Authentication Unit
P.O. Box 22001
Albany, NY 12201-2001
Customer Service: (518) 474-4429
Apostille/Certificate of Authentication Request
Please print or type. Submit this form with your documents. (Note: Incomplete forms will be returned for correction)
Country where documents will be used (Required):
(Consulate or Embassy Country)
Requestor's Name:
Name of Firm/Organization (If applicable):
Address:
Number and Street City State/Region Zip Code
Daytime telephone number: Email address:
Type of Return Mailer Enclosed: (You must enclose one of the following if documents are to be returned to you by mail.)
Self-addressed, First-Class envelope with prepaid postage
Self-addressed US Postal Priority or Express envelope with prepaid postage
Self-addressed prepaid carrier label; (FedEx, UPS, Airborne, or DHL)
Mailing Information:
If you are paying by check or money
order, mail to: (no cash or credit cards
accepted at this location)
New York Department of State
Division of Licensing Services
Apostille and Authentication Unit
123 William Street
New York, NY 10038
If you are paying by credit card,
mail to:
New York Department of State
Division of Licensing Services
Apostille and Authentication Unit
PO Box 22001
Albany, NY 12201-2001
For Department of State Use Only
Transaction # Date Processed: Cash Receipt #
Apostille 210cc
210dc
260 262
Number of documents: Special Deputy: County:
Fees/Payment:
(Checks/Money Orders must be payable to N.Y.S. Department of State)
Number of documents: X $10.00 per document = Total Due:
Form of Payment Enclosed or Authorized:
Check drawn on U.S. bank
Money Order from a U.S. bank
Credit/Debit Card - Accepted by Albany Office Only:
MasterCard Visa American Express
Name as it appears on card:
Billing Address:
City:
State:
Zip Code:
Card Number:
Expiration Date:
Payment Authorization; I authorize the New York Department of State to charge my credit/debit card for the amount due for the
authentication services provided by the Department of State.
Cardholder’s Signature:
Date:
If the name on the credit card or debit card is in the name of a
corporation or other business entity, please print the signer’s name:
DOS-1917-f (Rev. 09/21) page 1 of 2
Please note: If you utilize express services or next day
ground services such as UPS, Federal Express, DHL, etc.,
you should use the physical address of the building.
The Albany physical address is:
One Commerce Plaza
99 Washington Avenue, 6
th
Floor
Albany, NY 12231
Apostille/Certificate of Authentication Request
How do I obtain an Apostille or Certificate of Authentication from the New York Department of State?
1. Have your document notarized
2. Have your document certified by the County Clerk where the Notary is qualified
3. Complete the Apostille/Certificate of Authentication Request Form
4. Submit documents to be apostilled/authenticated with a completed Apostille/Certificate of
Authentication Request Form
5. Include applicable fees and mailing instructions as indicated on page 1 of this form
Please Note: The New York Department of State is unable to Authenticate/Apostille Federal Documents.
Background checks
Background checks from Division of Criminal Justice Services are required to be accompanied by a letter,
signed by the Commissioner or designee, verifying the fingerprint results.
Birth, death and marriage certificates
Birth, death, and marriage certificates issued by the New York State Department of Health and signed by the
Director of Vital Statistics may be submitted for Apostille/Authentication.
Birth, death, and marriage certificates issued by the New York City Department of Health must first be certified
by the New York County Clerk’s office. Additionally, birth and death certificates must be accompanied by a
Letter of Exemplification prior to being submitted to the New York County Clerk’s office.
Birth, death, and marriage certificates issued and signed by a local official (i.e. city/town/village clerk) must first
be certified by the County Clerk in the county where the document was issued.
Educational documents
Educational documents submitted to the New York Department of State for an Apostille or Certificate of
Authentication must first be certified by an official at the educational institution attesting that the document is an
official record or a true copy of the original document. The official’s signature then must be notarized by a
notary public. The notary public’s signature must then be certified by the County Clerk in the county where the
notary public is qualified.
All other documents
All other documents (such as power of attorney) must first be notarized. The notary’s signature must then be
certified at the County Clerk’s office where the notary is qualified.
Any questions about a specific county, please contact that county. You may contact the New York Department
of State at (518) 474-4429. For additional information, please visit our website at www.dos.ny.gov.
DOS-1917-f (Rev. 09/21) page 2 of 2
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ApostilleCertificate of Authentication Request (New York State)

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Completed 21 September 2021

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