(Proof is required for certified copy)
Applicant Details
Zip
Required Documents
Welfare
Valid photo driver's license or photo non-driver's license with current address OR valid driver's license without photo and an alternate form of ID with current address OR two (2) alternate forms of ID, one of which must show the current address.
To Request a Certified Copy of a Birth, Marriage, Civil Union, Domestic Partnership or Death Record
Veteran's Benefits
www.yourtown.us
Your Town
IN PERSON
How would you like to receive the record?
Social Security Disability
IMPORTANT!
Application for a Non-Genealogical Certification or Certified Copy of a Vital Record
Driver's License
Fill in the appropriate tabs that apply to the documents being requested.
Medicare
123 Main Ave
Please verify what town the event took place in. Certified copies of vital records are provided by the municipality where the event took place. A certification or certified copy of a vital record is available upon application only with proof of identity.
State
Present your completed application, valid proofs of identity, and payment of $10.00 for each certified copy requested.
Other SS Benefits
The applicant must present themselves to the Clerk's Office with proof of identity. Valid forms of identification is:
Reason for Request (check all that apply)
The fee due is $10.00 per each certified copy requested.
* Indicates required field
Fee Schedule
City
If available, I prefer the format of the certified copy to be:
(Must match address on ID)
First Name
Amount Due
b) The subject's parent, legal guardian or legal representative, or
Alternate forms of ID are: vehicle registration, vehicle insurance card, voter registration, US/foreign passport, permanent resident card (green card), Immigrant Visa, Federal/State ID, county ID, school ID, utility bill (within the previous 90 days), bank statement (within previous 90 days) or W-2/tax return for current or previous year.
School/Sports
(555) 555-5555
Social Security Card
e) a bank, title or insurance company requesting a copy of a death certificate for official business.
a) Proof that establishes you, the applicant, as the subject of record, or
Email Address
Last Name
Your Town, USA 00000
Phone #
Mailing Address
Passport
c) The subject's spouse/civil union partner, domestic partner; child, grandchild or sibling, if of legal age, or
Other (please specify)
Relationship to person on record
d) Court Order, or
  • Birth
  • Marriage, Civil Union or Domestic Partnership
  • Death
Father's Name (if on record)
County
Exact Date of Birth
How was it changed?
Full Name of Child at the time of Birth
Number of copies
New Name
Mother's Full Maiden Name
If the child's name was changed please indicate:
Place of Birth (City, Town)
Number of copies
Exact Date of Event
Place of Event (City, Town)
County
Name of Husband / Partner
Maiden Name of Wife / Partner
Name of Deceased
Name of Deceased Individual's Father
Place of Death (City/Town)
County
SSN #
Number of copies
Exact Date of Death
Maiden Name of Deceased Individual's Mother