DOH-4380 (09/19) p 1 of 2
• Complete a separate application for each record requested.
• Use this application to mail your request.
• Use this application if you are the person named on the birth certiﬁcate or if you are that person’s parent.
• Use this application if the birth occurred in New York State
of New York City.
Do not use this application if the birth occurred in any of the 5 boroughs of
New York City or Long Island Jewish Medical Center
For NYC birth call 212-639-6375 or visit http://www.nyc.gov/vitalrecords/
• Do not use this application for genealogy requests.
For genealogy requests: https://www.health.ny.gov/vital_records/genealogy.htm.
Enclose These Documents and Payment With Your Application
Required Identiﬁcation. You must send your application with copies of documents from List A or List B.
Note: You need to include a copy of your passport if the request is made from a foreign country that requires a U.S. Passport for travel.
Send a copy of 1 of the documents listed below. The document must include your photo and signature. It must also be current (not expired):
• Driver license
• Non-driver ID Card
• Other government issued photo-ID
If you do not have one of the documents in List A, send copies of 2 documents from List B. Each document should show your name and address.
• Utility bill
• Telephone bill
• Letter from a government agency dated within the last 6 months
Fees: If no birth record is on ﬁle, you will receive a document stating this. The document is called a No Record Certiﬁcation.
Your application fee will not be refunded.
• The total fee for one copy is $30. Total for 2 copies is $60., etc.
• Send check or money order payable to the New York State Department of Health. Do not send cash.
Note: Payment submitted from foreign countries must be made by a check drawn on a U.S. bank or by international money order. Do not send cash.
How to Mail the Application
• Mail application along with check or money order and a copy of the required documentation (see below).
Send by first class mail, registered mail, certified mail or U.S. Priority Mail to:
New York State Department of Health
Bureau of Vital Records Certiﬁcation Unit
PO Box 2602
Albany, NY 12220-2602
• 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 the required identiﬁcation.
Mail-in Application for Copy of Birth Certiﬁcate
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records