Application to Town Clerk for Copy of Marriage Record
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk for Copy of Marriage Record
TYPE OF RECORD DESIRED (Enter Number of Copies)
Search and
Certified Transcript
D
Fee $10.00
per copy
Search and
Certified Copy
D
Fee $10.00
per copy
A Certified Transaipt is an abstract from the marriage record issued under the
seal of the town/city derk. It indudes the names of the contracting parties, their
residence at the time the license was issued, date and place of marriage as well
as date and place of birth of the bride and groom.
A Certified Copy indudes all of the items of information occurring on the original
record of the marriage.
A Certified Transaipt may be used as proof that a marriage occurred.
A Certified Copy may be needed where proof of parentage and certain other
detailed information may be required such as: passports, veteran's benefits,
court proceedings, or settlement of an estate.
Name (as recorded on marriage license):
First .~
If Previously Married, State Name Used at that Time:
....,
BiIfh "-
Residence (at time of marriage):
Pm
Date of Birth:
(Of' .,.., fiIH of mmMgeJ
Name (as recorded on marriage license):
Pm .....
If Previously Married, State Name Used at that Time:
....,
Birth".",. if
Residence (at time of marriage):
Pm
T 0fIR Of' -
Purpose for which record is required:
T 0fIR Of'
Date of Marriage or Period
Covered by Search:
"""., fill Of'
S8n:b from:
In what capacity are you acting?:
What is your relationship to person whose record is required?
(If self, state "SELF".)
{mIIIllldlrmJ
SMn:h to:
(if --.., periodJ (mill I lid I rmJ
If attorney, give name and relationship of your client to person whose record is required:
Signature of Applicant
~
Date:
Applicant's Phone Number:
Name of Applicant:
Please print name and address where record is to be sent:
Address of Applicant:
City
DOH-301 (8/11) Page 1 of 2
State
ZIP
City
State
ZIP
Where to Apply for Record of Marriage
1. License Issued in New York State (Outside of New York City)
Year of Marriage
Apply to:
* 1881 to present ($10.00 per copy)
T own or City Clerk
Where license was issued (purchased)
* 1881 to present ($30.00 per copy)
If a state issued copy is required
or you are not certain in which city
or town outside of New York City
the license was issued.
New York State Department of Health
Vital Records Certification Unit
P.O. Box 2602
Albany, NY 12220-2602
www.health.ny.govjvitaLrecords/marriage.htm
* 1880 - 1907 and license issued in
the cities of Albany, Buffalo or
Yonkers.
Albany: City Clerk
City Hall - 24 Eagle St Rm 202
Albany, NY 12207
Buffalo: City Clerk
65 Niagara Square
Buffalo, NY 14202
Yonkers: City Clerk
40 S Broadway Rm 107
Yonkers, NY 10701
2. License Issued in New York City
Contact the office of the New York City Clerk for information if the marriage license was issued in any of
the five boroughs of New York City:
www.cityc/erk.nyc.gov
Manhattan
City Clerk of New York
141 Worth Street
New York, NY 10013
(212) NEW-YORK / (212) 639-9675
Brooklyn
Bronx
Queens
Richmond
(also known as Kings)
PLEASE NOTE:
(Records prior to 1898 are on file with the New York State Department of Health)
(also known as Staten Island)
(Records prior to 1898 are on file with the New York State Department of Health)
Records of marriages in areas of the present City of New York,
which were not part of the city at the time of marriage, are on file
with the State Department of Health.
DOH-301 (8111) Page 2 of 2