Information Page Mail-in Application for Genealogical Services
Use this application only for genealogy requests.
Print a copy of this application, complete and sign.
Mail application with check or money order and a copy of any required documentation (see below) to:
New York State Department of Health
Vital Records Section
P.O. Box 2602
Albany, NY 12220-2602
Fees: If no record is on file, a No Record Report will be issued and the fee is not refunded.
For standard search: This includes a three (3) year search. The fee is $22.00 per copy. The fee is for each
name or type of record requested.
For long search: When more than a three-year search is requested, the fee for each record in need of a longer
search is higher according to the following schedule:
The fee applies separately to each record
requested. For example, the fee for a request
consisting of one birth record (1-year search), plus
one death record (24-year search), plus one
marriage record (11-year search) is a total of
$166.00 ($22 + $82 + $62 = $166)
1 - 3 years $22.00
4 - 10 years $42.00
11 - 20 years $62.00
21 - 30 years $82.00
31 - 40 years $102.00
41 - 50 years $122.00
51 - 60 years $142.00
61 - 70 years $162.00
Send check or money order payable to the New York State Department of Health. Do not send cash.
Payment submitted from foreign countries must be made by a check drawn on a United States bank or by
international money order. Do not send cash.
No information shall be released from a record unless the person to whom the record relates is known to the
applicant to be deceased.
No information shall be released unless the record has been on file for a minimum required period: birth records
must have been on file for at least 75 years, death records for 50 years, marriage records for 50 years (both parties
to the marriage must be deceased).
The time periods above are waived if the applicant is a descendant and provides documentation of direct line
descent. A party acting on behalf of a descendant shall further provide documentation that the descendant
authorized the party to make such application.
Completing the Form
If you are using Adobe Reader 5.0 or newer (available as a free download from www.adobe.com) you can fill in
the form directly in Adobe Reader by clicking on the appropriate space and entering the information (use the TAB
key to move to the next field, shift-TAB to move backwards). Print the completed form, sign and mail to the
address shown above.
You can print out a blank copy of the form and then type or print the required information.
Be sure to sign the form before mailing and include a check or money order made payable to the New York State
Department of Health along with copies of any required documentation.
DOH-4384 (12/05) Page 1 of 2
For the latest information on processing times, please visit our web page at:
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
General Information and Application for Genealogical Services