T O W N O F W I L M I N G T O N
TOWN HALL
121 GLEN ROAD
WILMINGTON, MA 01887
OFFICE OF THE TOWN CLERK
PHONE (978) 658-2030
Christine R. Touma-Conway, Esq.
TOWN CLERK
FAX (978) 657-7564
MAIL-IN REQUEST FOR BIRTH RECORD
Certified copies of birth records are available from the community where the birth occurred, where both
parents(married) lived at the time of the birth (if in Massachusetts), and at the Massachusetts Registry of Vital Records
and Statistics.
If you are certain that the birth record is on file in this office, you may order a copy by printing this form, completing as
much detail as is available and mailing to the address above along with a check or money order made payable to the
"Town of Wilmington".
If you are not sure that the record is on file in Wilmington, you may call us at (978) 658-2030 to confirm.
Some records may be restricted. For example, if the parents were not married at the time of birth or the father is not
named on the record. Only those listed on these records are entitled to obtain a certified copy. You would have to
provide a copy of a photo identification issued by a government agency (i.e. valid driver's license).
Your mail-in request will be processed the day it is received. Certified copies of the records may also be obtained in
person at the Town Clerk's office.
Name of Child: ____________________________________
Date of Birth: _____________________________________
Father/Parent:______________________________________
Mother/Parent:_____________________________________
Number of Copies @ $10 each: _______________________
Your Name: _______________________________________
Address: ___________________________________________
City/State/Zip: _______________________________________
Signature: ___________________________________________
(Required for Restricted records - include copy of driver's license)
Phone or Email: ______________________________________
