Birth Certificate Application

IMPORTANT BIRTH CERTIFICATE INFORMATION

• You can obtain a birth certificate for yourself if you are at least 18 years old, or for your child, with current

identification. Detailed instructions for attorneys submitting requests on behalf of their clients are available

online at nyc.gov/vitalrecords.

• Falsifying information, including forging a signature, to obtain a birth certificate is a misdemeanor and violators

may also be subject to a fine of up to $2,000 per violation.

• Credit cards are not accepted for mail-in orders. If from outside the U.S., send an international money order.

• Check current processing times at nyc.gov/vitalrecords.

3 WAYS TO ORDER A NEW YORK CITY BIRTH CERTIFICATE

• Online: Visit nyc.gov/vitalrecords to order using a credit card, debit card or electronic check. Online orders

are processed within 24 hours on weekdays, and UPS express mail delivery is available.

• In Person: To make your request in person, you need to schedule an appointment online at

https://wb-nycdohmh.qmatic.cloud/qmaticwebbooking.

If you are unable to schedule an appointment and have an emergency request related to health care

coverage, government services, military, housing or employment, email [email protected]

or call 311.

The office is at 125 Worth Street in Manhattan and is open Monday through Friday, 9 a.m. to 3:30 p.m.

Use the Lafayette Street (handicapped accessible) or Centre Street entrances.

• By Mail: All mailed applications must be notarized. Mail your application to 125 Worth Street, CN-4,

Room 119, New York, NY 10013. Be sure to include a self-addressed, stamped envelope with your check

or money order payable to the NYC Department of Health and Mental Hygiene. You must provide a

photocopy of Category 1 identification or original copies of identification from Category 2 (see below).

Identification (ID) requirements to get a birth certificate for you or your child

Category 1: Identity documents. If you order in person you can leave with your short form birth certificate in

most cases, unless you require a long form birth certificate.

Provide any of the following if it includes your photo and your signature and is unexpired:

• Driver’s license or non-driver’s ID card

• NYS benefit card with photo

• U.S. or foreign passport or passport card

• IDNYC Municipal ID

• Permanent resident card

• University or college ID with a current transcript

• Inmate ID with current release papers

• Job ID with a current pay stub

• NYC Access-A-Ride card

• NYC MTA reduced fare card

• Military ID card

Category 2: Proof of address. If you do not have any of the above, you may provide proof of address as

described below. Your certificate will be mailed to the address on the documents provided.

Provide two different documents dated within the past 60 days, if they show your name and address (we will mail

you the certificate):

• Utility or telephone bills (online bills can be downloaded from your provider)

• Official government mail that you have received

If you cannot provide Category 1 or Category 2 identification, call 311 and ask for Vital Records assistance or

email [email protected]. If outside of NYC, call 212-639-9675.

VR 67 (Rev. 12.23)

To order birth certificates quickly and securely online through

VitalChek, visit nyc.gov/vitalrecords and click on ORDER

A BIRTH CERTIFICATE ONLINE at the top of the page.

To check the status of your order (newborn certificate,

birth certificate, death certificate, or birth or death certificate

correction), visit https://a816-evital.nyc.gov/eVitalVRRTS/.

Office of Vital Records

125 Worth Street, CN-4, Room 119

New York, NY 10013-4090

SEE INSTRUCTIONS AND APPLICABLE

FEES BELOW AND ON THE FIRST PAGE.

BIRTH CERTIFICATE APPLICATION

(Please print clearly and fill out as much information in English as you can. Forms submitted in other languages will take longer to process.

Translations of this form are available online for reference only — please fill out the English form in English.)

1. LAST NAME ON BIRTH CERTIFICATE 2. FIRST NAME

□ FEMALE

□ MALE □ X*

5. NAME OF HOSPITAL OR ADDRESS WHERE BORN 6. BOROUGH WHERE BORN

□ MANH □ BRONX □ BKLYN □ QUEENS □ SI

7. MOTHER/PARENT’S NAME BEFORE FIRST MARRIAGE (MAIDEN NAME)

FIRST LAST

8. BIRTH CERTIFICATE NUMBER (if known)

9. FATHER/PARENT’S NAME BEFORE FIRST MARRIAGE

FIRST LAST

10. WHY DO YOU NEED THIS BIRTH CERTIFICATE?

11a. DO YOU NEED A LONG FORM

BIRTH CERTIFICATE?**

□ YES □ NO

11b. DO YOU NEED A LETTER

OF EXEMPLIFICATION?***

□ YES □ NO

12. HOW MANY COPIES

DO YOU NEED?

□ 1 □ 2 □ 3

13. HOW ARE YOU RELATED TO THE PERSON ON THIS BIRTH

CERTIFICATE? SELF/PARENT/OTHER (please explain)

NAME

STREET ADDRESS APT. NO.

CITY STATE ZIP CODE

DAYTIME

PHONE

NUMBER

ADDRESS

CLEARLY PRINT YOUR MAILING AND CONTACT INFORMATION BELOW.

Area Code Telephone Number

14. CUSTOMER SIGNATURE AND DATE

SIGNATURE:

DATE:

15. CUSTOMER COMMENTS/ADDITIONAL INFORMATION

NOTE: A copy of a birth record can be issued only to a person to whom the record of birth relates, if of age, or to a parent or human service

organization. It is a violation of law to make a false, untrue or misleading statement or forge the signature of another on this application.

Violations are a misdemeanor punishable by a fine of up to $2,000.

4a. IF YOU KNOW THE EXACT DATE OF BIRTH 4b. IF YOU DO NOT KNOW THE EXACT DATE OF BIRTH

SEE BELOW

FOR FEE

INFORMATION

MM DD YYYY

BEGIN

MM DD YYYY

END

MM DD YYYY

FEES

$15 per copy x copies (maximum of 3) = $

Cost of certified copy includes a two-consecutive-year search

$3 for each extra year searched x

years = $

Total Amount Enclosed

(sum of the two $ amounts above): $

IF RECORD IS NOT ON FILE, A CERTIFIED “NOT FOUND STATEMENT”

WILL BE ISSUED. CASH IS NOT ACCEPTED BY MAIL OR IN PERSON.

CERTIFICATE REQUEST LIMIT: UP TO THREE.

APPLICATIONS SUBMITTED BY MAIL MUST

BE NOTARIZED

STATE OF

COUNTY OF

SUBSCRIBED AND SWORN BEFORE ME:

THIS DAY OF , 20

NOTARY PUBLIC SIGNATURE

NOTARY PUBLIC SEAL

ORDER BIRTH CERTIFICATES ONLINE QUICKLY AND SECURELY AT NYC.GOV/VITALRECORDS

*X is a gender that is not exclusively male or female (a nonbinary gender identity).

**A short form birth certificate can be used for most domestic purposes. It includes the child’s first and last names, date of birth, sex or gender marker, and the first and last names

of the mother/parent and father/parent. A long form birth certificate also includes the child’s place of birth and time of birth, the parents’ address and other information at the time

of birth, and information about the doctor who delivered the child.

***If you need a letter of exemplification, order a long form birth certificate.

VR 67 (Rev. 12.23)