Application for copy of
Birth Certificate
Name on birth record:
Date of birth: How many copies?
Parents → Mother’s maiden name:
Father’s name:
Applicant → Name:
Address:
City, State, Zip:
Phone/Email (optional):
In order to obtain a copy of this record, you must be one of the following (please check which you are):
Person named on the record Spouse or registered domestic partner
Mother or Father named on the record Descendant (children, grandchildren, etc.)
Legal custodian, guardian or authorized representative Registered Genealogist ID# __________
By my signature below, I swear/affirm that the information above is true and correct.
Applicant Signature: Date:
$15 for 1
st
copy, $6 for each additional copy
(make checks payable to “Town of Bar Harbor”)
IMPORTANT INFORMATION ON REVERSE
Clerk’s Initials:
MAIL-IN CHECK LIST
SIGN AND DATE
COPY OF PROOF OF IDENTIFICATION
PAYMENT IN THE PROPER AMOUNT
revised March 03, 2014
You must provide proof of identity with this application.
Applicant must provide one (1) of these (please check which you have provided):
Driver’s License Passport
Government issued picture I.D.
OR two (2) of these:
Utility bill Social Security Card
Bank statement DD 214 (Military Discharge)
Vehicle registration Hospital; birth worksheet
Income tax return License/rental agreement
Personal check with correct address Pay Stub
Previously issued vital record W-2
Letter from government agency requesting record Voter Registration card
Department of Corrections I.D. card Disability award from SSA
Other:
NOTES
We do not retain copies of proof provided or note any specific numbers.
Domestic Partners must provide proof of registration of domestic partnership.
Related applicants must provide proof of lineage.
Custodians, guardians or representatives must provide documentation.
Attorneys must provide a signed, notarized release from family.
Genealogists must provide a state-issued I.D. card.
Our Address is: Town of Bar Harbor
Clerk’s Office
93 Cottage St., Suite I
Bar Harbor, ME 04609-1400
Our Telephone Number is: (207) 288-4098
Make checks payable to: Town of Bar Harbor
revised March 03, 2014