Application for Genealogical Records
BIRTH
Date of Birth:
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, Non-driver's ID or US
Passport IDENTIFICATION
CANNOT BE EXPIRED
Proof of relationship (if needed)
Payment due is $11.00 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.
PLEASE NOTE: Uncertified copies or abstracts from records of birth, death and marriage
maybe be provided for genealogical research purposes subject to the restrictions specified
below:
A record of birth that has been on file for a minimum of 75 years and the person is known to be
deceased
A record of death that has been on file for a minimum of 50 years
A record of marriage that has been on file for a minimum of 50 years and both parties are
known to be deceased
Time periods can be waived if the application is a direct descendant and can provide
documentation of descendancy.
NO INFORMATION WILL BE RELEASED FROM A RECORD OF BIRTH THAT HAS
BEEN PLACED IN A CONFIDENTIAL FILE
ALL COPIES WILL BE CLEARLY MARKED WITH THE STATEMENT "FOR
GENEALOGICAL PURPOSES ONLY"
WE ONLY HAVE RECORDS FOR THOSE WHO WERE BORN, DIED OR OBTAINED
THEIR MARRIAGE LICENSE IN WHITE PLAINS. OUR RECORDS ARE FILED BY
YEAR SO THAT INFORMATION IS MANDATORY.
Father:
Name at Death:
Name at Birth:
Mother's
Maiden Name:
APPLICANT INFORMATION:
Full Name:
Address:
DEATH
MARRIAGE
Your relationship:
Bride:
Groom:
Date of Marriage:
Your relationship:
Your relationship:
Date of Death:
Telephone:
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