General Information and Application
For Genealogical Services
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Unit
P.O. Box 2602
Albany, New York 12220-2602
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE - $22.00 includes search and uncertified copy or notification of no record.
2. Original records of births and marriages for the entire state begin with 1881, deaths begin with 1880, EXCEPT for records filed in Albany,
Buffalo and Yonkers prior to 1914. Applications for these cities should be made directly to the local office.
3. The New York State Department of Health does not have New York City records except for births occurring in Queens and Richmond
counties for the years 1881 through 1897.
4. Please read the Administrative Rule Summary on the reverse side of this sheet which specifies years available for genealogical research.
To insure a complete search, provide as much information as possible.
Please complete the applicable section for each type of record requested: birth, death or marriage.
Birth
Birth
Name at Birth Name at Birth
State File
Number
State File
Number
Date of Birth Date of Birth
Place of Birth Place of Birth
Father's Name Father's Name
Mother's Maiden Name Mother's Maiden Name
Marriage
Marriage
Name of Bride Name of Bride
Name of Groom Name of Groom
State File
Number
State File
Number
Date of Marriage Date of Marriage
Place of Marriage
and/or License
Place of Marriage
and/or License
Death
Death
Name at Death Name at Death
Age at Death Age at Death
Date of Death Date of Death
Place of Death Place of Death
Names of Parents Names of Parents
Name of Spouse Name of Spouse
State File Number State File Number
For what purpose is information required?
What is your relationship to person whose record is requested?
In what capacity are you acting?
SIGNATURE OF APPLICANT DATE
Address
Phone
If requesting birth and marriage records, please sign the following
statement:
To the best of my knowledge, the person(s) named in the application
are deceased.
Send record to: (please print)
Name
Address
City State Zip Code
SIGNATURE OF APPLICANT
DOH-1562 (09/2004) Page 1 of 2
