2010
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Seelion, Genealogy Urit
P.O. Box 2602
Albany, New York 12220-2602
General Information and Application
For Genealogical Services
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE - $22.00 includes search and uncerti8d copy or noIicaIion of no record.
2. Original records of births" and meniages for the entire .... begin will 1881, deeh begi1 witt 1880, EXCEPT for records led in
AIIany, Buffalo and Yonkers prior to 1914. AppIcaIions tor these ciIiIs should be nile direcIIy to the local oftice.
3. The New York State Department of Health does not have New York City records except for births occuning in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the Administrative Rule Summary on the reverse side of this sheet which specifies years available for genealogical
research.
To insure a complete search, provide as much information as possible.
Please complete for type of record requested, birth, death OR marriage.
Name at Birth l3EU.f:" (~9) V,q.~ ~tA)~~
Date of Birth S /2 ~ J 1108
, 1
Place of Birth tuf\r'ih l\f~ AI f
Father's Name H 0 Lift Fs yip ~ N IN (+U lit Father's Name
Mother's Maiden Name r \) I\J 11 Fe IN ~~ ~b Mother's Maiden Name
For what purpose is information required? ~ L.. PrT IC:>~ ~)of Ii>
What is your relationship to person whose record is requested? V ~
In what capacity are you acting?
SIGNATURE OF APPUCANT ~~*~\P ~
ADDRESS e LfrlAJ.1 0
Send record to: (please print) If requesting birth and marriage records, please sign the following
statement:
Name 'RO ~1[ fn' It II R f\1 b) ~ 6'1'1~ To the best of my knowledge, the person(s) named in the application
? n. are deceased.
Address I 8 3 e> . h'1l ~ W
City 2JL. "Eft k~~ StateIJ rI Zip Code
Name of Bride
Name of Groom
Date of Marriage
Place of Marriage
and/or Ucense
Date of Marriage
Place of Marriage
and/or Ucense
Name at Death
Date of Death
Age at Death
Place of Death
Names of Parents
Name of Spouse
Name of Spouse
~~~i-
OOH-1562 (06/2003)
(over)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Urit
P.O. Box 2602
=:V' New York 12220-2602
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE - $22.00 includes search and UIKlIItI8d copy or notiIcaIion of no I8COI'd.
2. Original records of biths'and IIIIIITiages for the enh sbIfs begin wit 1881, de8Ihs begin wIh 1880, EXCEPT for records led in
Many, Buffalo and Yonkers prior 10 1914. Appbtians for..... ci881hou1d be II1Ide di8dIy 10 the local office.
3. The New York State Departmenfof HeaIh does nof have New York City records except for births occurring in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the AdninislratiYe Rule Sul1IIIIII'y on the reverse side of this sheet which speciIes years avdabIe for geneatogical
research.__~_ __
/J ;J r". . ~~~/ ~II no J #, ';_1JiJ ete search, provide as much information as possible.
UJ.A-{JUvtij....,U ~f ... Ir type of record requested, birth, death OR marriage.
r 'J)D)( (Y : _a1Bit11
~oxy
J)oy. $e '/
:D6;>< S ee.-
:DO'/. " e....
J)oxs., ~
General Information and Application
For Genealogical Services
Father's Name
Mother's Maiden Name
Place of Marriage
and/or UceRS8
Age at Death
For what purpose is information required? F(; (i:J i I Y (j f f7 c: () / ~ Y
What is your relalionship to p8rson)"\'<>so record is _led? _ ~r ~ 3~( e 01 t jf'tirJ del Q U3 h-ter
In what capacity are you acting? ~ ,') 0 n Cll G e. f) f _I ~__
'. . j .
SIGNATURE OF APPUCANT 'DATE I J. :< 7- /0
ADDRESS 3 P J . r
Send record to: (please print) If requesting birth and marriage records, please sign the following
Name K(J -1-1/] t e ]). )-{ a I ve y =~t of my knowledge, the person(s) named in the application
. Address 3 Po p I a r 'R d are deceased.
I
City 15 ta Co n State Ai Zip Code /250'1 SIGNATURE OF APPUCANT
OOH-1562 (06/2003)
(over)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Unit
P.O. Box 2602
=, New York 12220-2602
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE - $22.00 includes sewch and uncerfliBd copy or notiIc8Iiun of no record.
2. 0riginaJ records ofbirlhs'and marriages for the entire stile begin wIh 1881, deaIhs begiI witt 1880, EXCEPT for records filed in
Many, Buffalo and Yonkers prior to 1914. AppIcaIions for Ihese ciIies should be made di'ec:tIy to the IocaJ office.
3. The New York State Department ,of Health does nof have New York City records except for births occurring in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the Adninistrative Rule Summary on the reverse side of this sheet which specifies years avaiabIe for genealogical
research.
General Information and Application
For Genealogical Services
To insure a complete search, provide as much information as possible.
Please complete for type of record requested, birth, death OR marriage.
Date of Death 1892-1901
.DI f De th Wappinger
"nace 0 a
Age at Death
Date of Birth
Name at Birth
Name at Birth
Date of Birth
Place of Birth
Place of Birth
Father's Name
Father's Name
Mother's Maiden Name
Mother's Maiden Name
Name of Bride
Name of Bride
Name of Groom
Name of Groom
Date of Marriage
Place of Marriage
and/or Ucense
Name at Death Egbert Penny or Egbert Penney
Date of Marriage
Place of Marriage
and/or Ucense
Name at Death
Date of Death
Age at Death
Place of Death
Names of Parents
Name of Spouse
Name of Spouse
1=d'r 'Nhat purpose is information required? _ Gene~logy
What is your relationship to person whose record is requested?_ None
I h t"ty t' ? Researcher for Great GreatGranddaughter
nw a capac. areyouac~ _~.
SIGNATURE OF APPUCA ~
ADDRESS P.O, Box 50561 Provo UT 84605
Send record to: (please print)
DATE ~- ~ ;20/0
Frankie Davis
Name
Address P.O. Box 50561
City Provo
If requesting birth and marriage records, please sign the following
statement
To the best of my knowledge, the person(s) named in the application
are deceased.
State UT
Zip Code 84605
SIGNATURE OF APPUCANT
OOH-1562 (06/2003)
(over)
N D ~1cl
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Unit
P.O. Box 2602
Albany, New York 12220-2602
General Information and Application
For Genealogical Services
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE - $22.00 includes search and uncertified copy or notification of no record.
2. Original records of births and marriages for the entire state begin wIh 1881, deaths begin with 1880, EXCEPT for records filed in
Albany, Buffalo and Yonkers prior to 1914. Applicalions for these cities should be made dnctJy to the local office.
3. The New York State Department of Health does not have New York City records except for births occurring in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the Administrative Rule Summary on the reverse side of this sheet which specifies years available for genealogical
research.
To insure a complete search, provide as much information as possible.
Please complete for type of record requested, birth, death OR marriage.
Father's Name
Name at Birth
Date of Birth
Place of Birth
Father's Name
Mother's Maiden Name
Name of Bride
Name of Groom
Date of Marriage
Place of Marriage
and/or Ucense
Name at Death Ed WI (l ])o''/. cy
Date of Death n lJ.t) 'y /94,ie at Death 29
Place of Death '10 uJn o-F W Q ~ e.!
Names of paremS.ara h J)dnl\O' uJtI!uJm ,i)o~id
, j I J)()J(tt
NameofSpousefilOrIf15m,+h .
Age at Death
Names of Parents
Name of Spouse
For what purpose is information required? (7) 0) P <.; I ~ i(Q I flu fPO S e s-Proof .(br L i n tQje S () C I et+-
What is your relationship to person whose. rrord is requested?351J r a Q d dOUjh-f c r
In what capacity are you acting? j C I
/. /)
/ l.^e' /
SIGNATURE OF APPUCANT \
ADDRESS 3 r
Send record to: (please print)
Namef{QtJl1 (A :D, Holvey
Address ,--3 t1J 0 ) Q r 1< cl
I
CitvJ3e.G 6Jn
DATE /O')j, 10
If requesting birth and marriage records, please sign the fol/owing
statement
To the best of my knowledge, the person(s) named in the application
are deceased.
StateA.-l \
Zip Code 12503
SIGNATURE OF APPUCANT
DOH-1562 (06/2003)
(over)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Unit
P.O. Box 2602
Albany, New York 12220-2602
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
General Information and Application
For Genealogical Services
1. FEE - $22.00 includes search and uncertified copy or notification of no record.
2. Original records of births and marriages for the entire state begin with 1881, deaths begin with 1880, EXCEPT for records filed in
Albany, Buffalo and Yonkers prior to 1914. Applications for these cities should be made directly to the local office.
3. The New York State Department of Health does not have New York City records except for births occurring in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the Administrative Rule Summary on the reverse side of this sheet which specifies years available for genealogical
research.
To insure a complete search, provide as much information as possible. Please complete for
type of record requested, birth, death OR marriage.
Name at Birth
Date of Birth
.c
1:: Place of Birth
.-
m
GJ
Q
ftI
.-
..
..
ftI
E
Name at Death
.c Date of Death
...
ftI
GJ
Q
Age at Death
Place of Death
Names of Parents
Name of Spouse
For what purpose is information required? Genealogy
What is your relationship to person whose record is requested? Great Great Great Grandson
In what capacity are you acting? my own
SIGNATURE OF APPLICANT ft~p ~
ADDRESS b~ ~7tI Sf ~R'~tI tfrff (lZ-Jb~
DATE
Cf liP / ;;0/0
7,f(- fit -Y]7!
Send record to: (please print)
N Peter McGurk
ame
Address 66 Allen St
City Randolph State MA Zip Code 02368
DOH-1562(p) (03/2004)
I ~OO,
'{em J .
Phone
If requesting birth and marriage records, please sign the following
statement:
To the best of my knowledge, the person(s) named in the application
are deceased.
SIGNATURE OF APPLICANT
(over)
September 18, 2010
66 Allen St
Randolph, MA 02368
Chris Masterson
Town of Wappinger Town Clerk
20 Middlebush Road
Wappingers Falls, NY 12590
Dear Chris,
Thanks so much for your assistance in obtaining the death
certificate of Mary Ridings. After success with that request, J'm hoping
we can find the certificate for her husband Thomas Ridings.
Thomas is my great-great-great grandfather. He lived his wife on
Brown Ave in Wappingers Falls. I don't know the exact date of his
death, but believe he died between 1880 and 1889. He was born in
England in 1806 so he would have been about 74 to 83 years old at
time of death. To the best of my knowledge his fathers name was John
and his mother's name may have been Jane.
J have enclosed a check for $42.00 for a 4-10 year search along with
a completed DOH-1562 form.
Sincerely,
;4OJfl~
Peter D McGurk
t:.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Urn
P.O. Box 2602
Albany, New York 12220-2602
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE - $22.00 iIcIudes 88W'ch and UI1CIftiI8d copy or nalilcalion of no rICOrd.
2. OrigNl records of biths.and marriages for the enIi'e ... begin will 1881, dealhs begil witt 1880, EXCEPT for records fled in
Albany, Buffalo and Yonkers prior to 1914. AppIcaIions for.... cilie81hou1d be I1IIde directly to the Ioc8I office.
3. The New York State Department.of Health does not have New York City records except for births occurring in Queens and
Richmond counties forlhe years 1881 through 1897.
4. Please read the Adninillrative R" Summary on the reverse side of this sheet which specifies years avalable for genealogical
research.
General Information and Application
For Genealogical Services
To insure a complete search, provide as much information as possible.
Please complete for type of record requested, birth, death OR marriage.
RK
Name at Birth
Date of Birth
Place of Birth
Father's Name
Mother's Maiden Name
Name of Bride
Name of Groom
Date of Marriage
Place of Marriage
and/or Ucense
Date of Marriage
Place of Marriage
and/or Ucenae
Name at Death M 1112-1{ /2/ /J / Ntf-S
Date of Death ,4!>>vr I f'f tJ Age at Death g i
Place of Death tA/J1fJjJ;tYtft!ZS hIt?~ NY
I
Names of Parenti I%fflrft'1' vYlU/~ f 4.1~ &/t4r
Name of Spouse 7f/t1Jt1./K b/J /il6.S'
Age at Death
For what purpose is information required? - (:;
What is your relationship to person whose record is requested? 3;e.j) C ta;;1I7 t:'i'!lflYtJS"CI IV'
In what capacity are you acting? /tt Y ClW Jf/
SIGNATUREOFAPPUCANT d~ a~ DATE ?--//- ~/c)
ADDRESS ~tb /JUb/V 5/ /tMIl!ftf/~ ~A O"2--~bR
Send record to: (please print) If requesting birth and marriage records, please sign the following
Name fb--n-12- tf{ ({u;tK =:.t of my knowledge, the person(s) named in the application
..--r- are deceased.
Address 6h /ftU::-1V f? /
City JUIIitt/ JI State kit Zip Code tJ2jt ~ SIGNATURE OF APPUCANT
DOH-1562 (~)
(over)
....
-:,
September 111 2010
66 Allen St
Randolphl MA 02368
Chris Masterson
Town of Wappinger Town Clerk
20 Middlebush Road
Wappingers Fallsl NY 12590
Dear Chrisl
I am requesting the death certificate of Mary Ridings who is my
great-great-great grandmother. She lived with her husband Thomas on
Brown Ave in Wappingers Falls. I don/t know the exact date of her
deathl but I found her listed as living on Brown Ave in Wappingers Falls
in 1889 so she must have died in late 1889 or after. I think she was born
in England in 1806 so if she died in 1890 she would have been about 84
years old.
I have enclosed a check for $22.00 for a 1-3 year search along with a
completed DOH-1562 form.
SincerelYI
4M~~
Peter D McGurk
\8/'/ YORf( STATE DEPARTMENT OF HEALTH
\:ital Records Section. Genealoqv Unit
r.O. Bo)( 21i02
Atbany. New York 12220-2602
General Information and Application
For Genealogical Services
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCiAL PURPOSES.
1. FEE - $22.00 includes search and uncerfified copy or notification of no record.
2. Original records of births and marriages for the entire state begin with 1881, deaths begin with 1880, EXCEPT for records filed ill
Albany, Buffalo and Yonkers prior to 1914. Applications for these cities should be made directly to the local office.
3. The New York State Department of Health does not have New York City records except for births occurring in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the Administrative Rule Summary on the reverse side of this sheet which specifies years avaffable for genealogical
research.
To insure a complete search, provide as much information as possible
Please complete for type of record requested, birth, death OR marriage.
Name at Birth
Date of Birth
Place of Birth __._......
- -'-'-_._.__.._.._._~"~."._---_.,-_._---,...~-_._._,-----._-----
Father's Name
Mother's Maiden Name
Name of Bride CAR me- J..,A Po-tA t... I v t>
Name of Groom ['( 0 c- C. b C A- yY} P 14- 1- A
;,..." 7
. ': Date of Marriage I '1 () a ~ J Cj J. 4 bV J 9 ()S
Place of. Marriage F 1\ FA/.. J.. 5
and/or ucense
Name ai Death
Date of Death
Age at Death
Place of Death
.
~.#i~t
:';'.;.~:::':;'-
it;~;~~~t
~;'~;';.N
Names of Parents
Name of Spouse
For what purpose is information required?
What is your relationship to person whose record is requested?
I
!
I
f
f
... I
Age at Death
() ~ -R.AJ:7J"if
~/l. -6-<.1
In what capacity are you acting?
SIGNATUREOFAPPUCANT ~ ';/~.LAfi/
ADDRESS
DATE 7) J-& J c;OIO
I I
""""
Send recore! to: (please prtnt]
Name PJ-fl ~()M &'#,4 L.AR, DEAR
If requesting om" and mamage records, please sIgn me TOHowmg
statement:
To the best of my knowledge. the person(s) named in the apphcallon
are deceased.
Address,,] [ I J./. G f<. r;. e;1/ 51.
City e t.f' '/.r>1M...-r - JJL- Zip Code I q7 tJ3 ~L ~ C~)
OOH-1562 (061200O)
NO ((QC1Jrw-funcJ,
(over)
~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Urit
P.O. Box 2602
=', New York 12220-2602
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE - $22.00 inc:IudIIlMdI and ...a.d copJor 00&.... of no NCOrd.
2. Original records of births and mIIll..... for the IIIIi'e ... begin wit 1881, d88Ihs begit wIh 1880, EXCEPT for records fled in
Many, BuIaIo.... YanIfera priDrlD 1914. AppbIioaa for... ciIiIIlhauId be lIIIlIedir8dlyfothe Ioc8I ofIce.
3. The New York Stale Deptlrbnent.of HeaIh does not have New York Cily records except far births occurring in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the Adninilllrative Rule Sumnry on the nlV8118 aide of Ibis Ihe8t which 11I*1.1 ,..lV8IabIe for genealogical
1'II8arch.
General Information and Application
For Genealogical Services
Date of Death
Age at Deldh
Dill of Birth
Place of Birth
To insure a complete search, provide as much information
Please complete for type of record requested, birth, dea
Name at Birth
Date of Birth
Place of Birth
FaIhe~s Name
F8lher's Name
MoIher's Maiden Name
Moller's Maiden Name
Name of Bride EAJ A FeR t.Je.Rd,,--
Name of Groom L~, ER AAJ d (2 y
I
Date of Marriage kb Rl.LkR.1 10 I 11 if 0
Place of Maniage tv ft tJ Pi .AJG E. R. FALLS
and/or Ucense
Name of Bride
Name of Groom
Name at Death
Dill of Maniage
Place of ManiIge
"'or Ucense
Name at Death
D818 of Death
Place of Death
NaII* of PII'IIU
Name of SpouIt
Age at Death
Place of Death
Names of p8I8f1IB
Name of Spolll8
For what plI'pOSe is information required? ~Q..-J..O rs, Y
What is your relationship to person e record" led? R~ ~a_J~c..f1t:.{C
In what capacity are you acting?
SIGNATURE OF APPUCANT:
,
ADDRESS 0
Send record to: (please print)
Name c.Hr IS-!o;Jhee t KDJ,vt4~
Address~ .k~ (IJARY PI tlCe.
City tJQ0 &RVAJSw,c'it.tJJ Zip Code D81 DI
OOH-1562(06,I2008)-I- EtJ A cJ/~d (~11) ,I...e...STCC<..
If requesting birth and marriage recorda, please sign the foHowing
statement
: the best of';" kIlO i . the pelSon(s) named in the application
(OWl)
June 10, 2010
Town of Wappinger Town Clerk
20 Middlebush Road
Wappinger Falls, New York 12590
Attn: Chris Masterson
Greetings,
As a family historian tracing the Ferwerda family, I seek the marriage
record of Ena Ferwerda (1906-1971) and Lester Andry (1911-1996).
According to the NYS Vital Records Index, the couple was married in
Wappingers Fallon February 10, 1940. Enclosed please find a copy of
form DOH-1562 for your convenience and $22.00 to cover the costs.
You can send the record to the address below. If you have any questions
or concerns about this matter, feel free to contact me.
Christoph r Brennan
31 Seminary Place
New Brunswick, New Jersey 08901
cristoir@optonline.net
~~
cL}Jt1 Jr4!
- .
'NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Unit
General Information and Application for Genealogical Services
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
Return to: New York State Department of Health, Vital Records Section, P.O. Box 2602, Albany, NY 12220-2602
1. FEE - $22.00 includes search and uncertified copy or notification of no record.
2. Original records of births and marriages for the entire state begin with 1881, deaths begin with 1880, EXCEPT for records filed in Albany,
Buffalo and Yonkers prior to 1914. Applications for these cities should be made directly to the local office.
3. The New York State Department of Health does not have New York City records except for births occurring in Queens and Richmond
counties for the years 1881 through 1897.
4. Please read the Administrative Rule Summary on the reverse side of this sheet which specifies years available for genealogical research.
To insure a complete search, provide as much information as possible.
Please complete the applicable section for each type of record requested: birth, death or marriage.
Name at Birth Name at Birth
State File State File
.c Date of Birth Number .c Date of Birth Number
~ Place of Birth ~ Place of Birth
.- .-
m m
Father's Name Father's Name
Mother's Maiden Name Mother's Maiden Name
CII Name of Bride & Name of Bride
C\
ra Name of Groom fa Name of Groom
.- o-
r.. Slate File '- State File
r.. '-
ra Date of Marriage Number fa Date of Marriage Number
:E Place of Marriage 2: Place of Marriage
and/or License and/or License
Name at Death A. Y\ n -€.. EVQ.ns Name at Death
Date of Death 1 ex. n , \93 \ Age at Death 77 Date of Death Age at Death
.c - \\)0 .c
..., Place of Death \\JCl~pl"~US t-D..\\", \ ..., Place of Death
ra fa
CII m cd 6t:. (\ Y\ ~M<:" ell
Q Names of Parents "''''\'-how 1'\ - C \..>1\ r"\\ f\'JhQW'\ C Names of Parents
Name of Spouse m;c\\a.e\ ( " Ct." " Name of Spouse
State File Number State File Number
For what purpose is information required? ~ e..1'\~o... ~o ~ ~
What is your relationship to person whose record is requested? G Ie D.. \- - ~ (" e D.. \.
~ (c.."~ ~Q <J1~+-e.r
In what capacity are you acting?
SIGNATUREOFAPPLlCANT ~VI\[\J.. <s~ DATE mCL'j S) 20/0
Address J-S Cn6Y\,?~ tool\\ \j,)o.."\-GL:l<= NJ Dll.f~( Phone ~/3-37S-2S2i
Send record to: (please print) If requesting birth and marriage records, please sign the following
statement:
Name CS "" er {'I ~ C ().Io-'f"\ D To the best of my knowledge, the person(s) named in the application
\ are deceased.
Address ~ S tOf'l'"\ f \M 12.0 ~
City State N J Zip CodeD 7 Lf ~ I
SIGNATURE OF APPLICANT
DOH-4384 (12/05) Page 2 of 2
/
~D
"
..
Sherri Scarano
25 Compton Road
Wantage, NJ 07461
May 5, 2010
I am requesting a death record for Anne Evans, maiden name Cunningham, who
died January of 1931. Enclosed is a check in the amount of $22.00, which is the
fee listed on the NYS information and application for genealogical services. I have
also enclosed a SASE and a photo ID.
Thank you,
Sherri Scarano