REQUEST FOR A CERTIFIED COPY OF A BIRTH CERTIFICATE
WHAT TO INCLUDE IN YOUR REQUEST
Completed Request Form
including original ink signature.
REQUEST PAYMENT
ID
RETURN
Payment - check or money order payable to
City of Boston. Certificates cost $14.00 per
copy when ordered through the mail.
Requests prior to 1870 require an additional
$10 research fee on a separate check, and
this fee is not refundable.
A copy of your Identification
(Driver’s License, State ID,
Passport).
Please include a self-addressed
stamped envelope.
Registry - Birth
One City Hall Square
Room 213
Boston, MA 02201
City of Boston
REQUIRED INFORMATION
NUMBER OF COPIES:
DATE OF BIRTH:
FULL NAME:
PARENT 1 FULL NAME:
MAIDEN NAME IF APPLICABLE:
PARENT 2 FULL NAME: MAIDEN NAME IF APPLICABLE:
NAME OF HOSPITAL OR LOCATION OF BIRTH:
PERSON REQUESTING THE CERTIFICATE:
RELATIONSHIP OF REQUESTOR TO SUBJECT NAMED ON RECORD:
RETURN MAILING ADDRESS:
SIGNATURE OF REQUESTOR:
PHONE NUMBER: EMAIL ADDRESS:
Month/Day/Year
--
If a child’s parents were not married at the time of the child’s birth, then the record is restricted. ONLY those listed on the birth
certificate can request a copy and identification is required to obtain the record.
Check here for Time of Birth Only: If you are just requesting your “Time of Birth,” you only need to enclose a $10 research
request fee instead of the certificate cost. Please note that not all years list time of birth.
If we do not have the record we will call and/or return the check in the self-addressed stamped envelope that you have included
with your request.
The Registry Division is open weekdays from 9 a.m.- 4 p.m. except holidays | boston.gov/registry | 617-635-4175
OFFICE USE ONLY
Date Rc Ck or MO
Date Mailed
$
MAIL or TRUCK
# of Copies Rec#
/
Return Env ID IncludedYES or NO YES or NO Staff
click to sign
signature
click to edit
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