Fillable Mail-in Application for Copy of Divorce Certificate Information (New York State)

Fill Online, Printable, Fillable, Blank Mail-in Application for Copy of Divorce Certificate Information (New York State) Form

Use Fill to complete blank online NEW YORK STATE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Mail-in Application for Copy of Divorce Certificate Information (New York State)

On average this form takes 10 minutes to complete

The Mail-in Application for Copy of Divorce Certificate Information (New York State) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 41 other fields

Country of origin: US
File type: PDF

Free fillable forms for New York State

BROWSE NEW YORK STATE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
DOH-4378 (7/11) Page 1 of 2
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Mail-in Application for Copy of Divorce Certificate
Information Page — Mail-in Application for Copy of Divorce Certificate
General Instructions
• Use this application if you are the wife, husband or spouse named on the divorce certificate.
• If you are not the wife, husband or spouse named on the certificate, then you must submit with this application a copy of a New York State
Court Order requiring the divorce certificate.
• Use this application only if the divorce was granted in New York State (including New York City) on or after January 1, 1963. Contact the
county clerk of the county where the divorce was granted if prior to January 1, 1963.
• Do not use this application for genealogy requests.
• If delivery is to a P.O. Box or to a third party you must submit, with this application, a not arized statement signed by the wife, husband or
spouse and a copy of the wife, husband or spouse's driver license.
To order by mail, sen
d by first class mail, registered mail, certified
mail or U.S. Priority Mail to:
New York State Department of Health
Vital Records Certification Unit
P.O. Box 2602
Albany, NY 12220-2602
Who is eligible to obtain a divorce certificate copy?
• If the applicant is not the wife, husband or spouse, a New York State Court Order is required to obtain a copy of the divorce certificate.
• A copy of the New York State Court Order must be submitted along with the application if the request is being made by someone other than
the wife, husband or spouse on the record.
Identification Requirements -- Application
must
be submitted with copies of either A or B:
Note: Copy of Passport required if request is made from a foreign country that requires a U.S. Passport for travel.
One (1) of the following forms of valid photo-ID:
• Driver license
• State Issued Non-Driver Photo-ID Card
• Passport
• U.S. Military Issued Photo-ID
-- OR --
Two (2) of the following showing the applicant's current name and address:
• Utility or telephone bills
• Letter from a government agency dated within the last six (6) months
Fees: If no record is on file, a No Record Certification is issued and the fee is not refunded.
• The fee is $30.00 per copy. — Total for one (1) copy is $30.00. Total for two (2) copies is $60.00, 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 United States bank or by international money order.
Do not send cash.
Compl eting the Form
®
• If you are using Adobe Reader 7.0 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 above address.
• You can print out a blank copy of the form and then type or pri nt 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 any required documentation.
For Expedited order placement and processing:
Please visit
www.VitalChek.com
or call VitalChek Network, Inc. at 877-854-4481
DOH-4378 (7/11) Page 2 of 2
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Mail-in Application for Copy of Divorce Certificate
If you are not the wife, husband or spouse named in the Decree, you must submit copy of New York State Court Order.
Date Signed:
Month Day Year
Signature of Applicant:
Certified Copy
$30.00 x
Copies = $
Please print or type the name and address where record
should be sent:
(If delivery is to a P.O. Box or third party, you must submit
with this application a notarized statement signed by the applicant and a copy of
the applicant's driver license.)
Address of Applicant:
(Applicant's Name)
(Name)
(Street)
(Street)
(City) (State) (Zip)
Telephone No.: ( )
(City) (State) (Zip)
Required ID must be included with application. Make check or money order payable to New York State Department of Health.
Mail Order Certified Copy Fee: Enclose $30 per copy or No Record
Certification. Send to:
New York State Department of Health
Vital Records Certification Unit
P.O. Box 2602
Albany, NY 12220-2602
Name:
Wife/Husband/ Spouse
Address at Time of Decree:
Wife/Husband/ Spouse
First Middle Last Birth Name (if different)
Town or City County
Divorce Certificate No.:
(if known)
Date of Final Decree or
Period Covered by Search:
Decree Issued on
or Search from:
In what capacity are you acting?:
(mm / dd / yyyy)
Search to:
(if searching period)
(mm / dd / yyyy)
What is your relationship to person whose record is required?
(If self, write "SELF".)
If attorney, give name and relationship of your client to person whose record is required:
Place Where Marriage License Was Issued:
Town or City County
Marriage and Divor ce Information
Local Registration No.:
(if known)
Purpose for which record is required?
County in Which Divorce Decree Was Filed:
Date of Marriage:
Name:
Address at Time of Decree:
First Middle Last Birth Name (if different)
Town or City County
(mm / dd / yyyy)
For Expedited order placement and processing:
Please visit
www.VitalChek.com
or call VitalChek Network, Inc. at 877-854-4481
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Mail-in Application for Copy of Divorce Certificate Information (New York State)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 14 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document