Application for Birth Certificate
Payment due is $10.00 per copy
In Person:
We accept cash, money order,
MasterCard, Visa and American Express.
By Mail: We only accept money orders
made payable to "The City of White
Plains"
We do not accept personal checks.
CERTIFICATE INFORMATION:
First Name Middle Name Last Name (at birth) Date of Birth
Place of Birth Village, Town or City of Birth
Full Maiden Name of Mother Father:
Purpose record is
required
APPLICANT INFORMATION:
Full Name Relationship
Telephone Number Address
Signature
_________________________________________
Date
City Clerk 255 Main Street White Plains, NY 10601 (914) 422-1227
YOUR CHECKLIST:
Identification Requirements (One of the following)
Driver's License or Non-driver's ID
Passport or Naturalization Papers
Military ID
Two (2) different (and current) utility bills showing applicant's
name and address
Police report of lost or stolen ID
IDENTIFICATION CANNOT BE EXPIRED
PLEASE NOTE: Copies of birth certificates are only available to the person named on the certificate (18
years or older), the person's parents, legal guardian (custodial documents are required) or anyone who
presents a court order.
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