12/2019
Town of Trumbull
Request for Birth Certificate
For the protection of the individual, certificates of birth are not open for public inspection in accordance with the
Connecticut General Statutes 7-51. If the person making this request is not the person named in the certificate, the
following must be completed in order to permit this office to comply with the request.
Relationship to person named in this certificate (self, parent, attorney):
Your Signature:
Address:
Full certified copy - sufficient for all legal purposes. $20.00 each
If the person requesting the copy is a minor (under 18 years of age),
parent or guardian must sign the request.
Certification of birth wallet size $15.00 each
Date of Birth: Gender:
Full Name at Birth:
Mother’s Full Maiden Name: Birthplace:
Father’s Full Name: Birthplace:
Identification required, if mailing please send copy of driver's license or photo identification to:
Trumbull Town Clerk
5866 Main Street
Trumbull, CT 06611
Mary Markham
Trumbull Town Clerk
(203) 452-5037
Driver’s License #:
State #:
Quantity:
Quantity:
click to sign
signature
click to edit
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