Fillable MAIL IN REQUEST FORM FOR BIRTHS OCCURING IN (City of Cambridge, Ma)

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MAIL IN REQUEST FORM FOR BIRTHS OCCURING IN (City of Cambridge, Ma)

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The City of Cambridge
Office of the City Clerk
795 Massachusetts Avenue
Cambridge, MA 02139
617-349-4260
Mon. 8:30 am to 8:00 pm
Tues., Wed. & Thur.
8:30 am to 5:00 pm
Fri. 8:30 to Noon
MAIL IN REQUEST FORM FOR
BIRTHS OCCURING IN CAMBRIDGE OR
RESIDENTS OF CAMBRIDGE AT THE TIME OF BIRTH
YOUR REQUEST SHOULD INCLUDE:
1. The completed request form
2. Payment of $10.00 per certified copy - check or money order payable to the City
of Cambridge
3. A self-addressed, stamped envelope
4. If the parents were unmarried at the time of the child's birth, the record is
restricted and requires a photocopy of a valid ID (such as a driver's license)
from the individual, a parent listed on the record, or a legal guardian (with a
copy of a court order)
Please allow one week for mail requests to be filled
PLEASE TYPE OR PRINT
FULL NAME OF
PERSON ON RECORD
Last
DATE OF BIRTH
FULL NAME OF
FATHER / PARENT 1
FULL MAIDEN NAME OF
MOTHER / PARENT 2
APPLICANT'S NAME
MAILING ADDRESS
DAYTIME PHONE E-MAIL
RELATIONSHIP TO PERSON
WHOSE CERTIFICATE IS
REQUESTED
First Middle
LastMiddleFirst
LastMiddleFirst
LastMiddleFirst
Street City State (Abbr.) ZIP code
Please Note: If you need expedited service and have a major credit card you may also contact the Division of Vital Statistics at (617) 740-2600 or 740-2606.
They have all Massachusetts records for the years 1911 through the present. Call them for fee information, as their fees are different than this office.
Signature of Applicant Date
NUMBER OF
CERTIFIED COPIES
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MAIL IN REQUEST FORM FOR BIRTHS OCCURING IN (City of Cambridge, Ma)

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Completed 17 August 2020

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