TOWN CLERK’S OFFICE
Town of Milford
VITAL RECORDS BIRTH REQUEST FORM BY MAIL
To order one or more certified copies of a birth record, please complete this form and return it with a self-
addressed, stamped envelope and $10.00 cash or money order made payable to the “Town of Milford”.
Sorry, we do not accept personal checks; all personal checks will be returned. Debit & credit cards are
only accepted online or in the office (with a fee).
Mail your request to:
Milford Town Clerk
52 Main St., Room 12
Milford, MA 01757
FULL NAME AT BIRTH:
DATE OF BIRTH: month:
day:
year:
NAME
OF MOTHER:
NAME
OF FATHER:
NUMBER OF COPIES: X $10.00 = AMOUNT ENCLOSED: $
*If the parents on the birth record were NOT married at the time of birth, this makes the birth record restricted
to anyone other than those named on the birth record. To receive a restricted record, please email a copy of
your valid driver’s license to dnaff@townofmilford.com
Please fill in your information as to where we should mail the birth certificates:
NAME OF REQUESTOR:
MAILING ADDRESS:
CITY, STATE, ZIP:
Should we need to contact you regarding this request please complete the following:
TELEPHONE #:
EMAIL ADDRESS:
