Application for Genealogical Search
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 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
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Mother's Maiden Name
Name at Birth
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Date of Birth
Date of Birth
Place of Birth
Place of Birth
Father's Name
Father's Name
Mother's Maiden Name
Name of Spouse
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Name of Bride
Name of Bride
Name of Groom
Name of Groom
Date of Marriage
Place of Marriage
and/or Ucense
Date of Marriage
Place of Marriage
and/or Ucense
Name at Death
Name at Death
Date of Death
Age at Death
Date of Death
Age at Death
Place of Death
Place of Death
Names of Parents
Names of Parents
Name of Spouse
For what purpose is information required?
What is your relationship to person whose record is requested?
In what capacity are you acting?
SIGNATURE OF APPLICANT
ADDRESS
Send record to: (please print)
DATE
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.
Name
Address
City
DOH-1562 (06/2003)
State
Zip Code
SIGNATURE OF APPLICANT
(over)
Health Commissioner's
Administrative Rules and Regulations
Summary
1. Genealogical Research
Uncertified copies or abstracts from records of birth, death, and marriage may be provided for
genealogical research purposes subject to the restrictions specified in this summary. All requests
must be submitted in writing and include payment of the applicable statutory fee. The applicant shall
be required to pay the specified fee for the time spent for the search and uncertified copy of
notification of no record.
2. Who is authorized to do the searching?
Record searches shall be conducted only by the following persons in the files maintained by their
respective agencies:
a. authorized employees of the State Department of Health;
b. 'a local registrar, deputy registrar, or an authorized employee of the registrar;
c. a town or city clerk, deputy clerk, or an authorized employee of the town or city clerk.
3. What records are available?
a. No information shall be released from a record of birth which has been placed in a confidential file
pursuant to Public Health Law Section 4138.
b. No information shall be released from a record of birth unless the record has been on file for at
least 75 years and the person to whom the record relates is known to the applicant to be
deceased.
c. No information shall be released from a record of death unless the record has been on file for at
least 50 years.
d. No information shall be released from a record of marriage unless the record has been on file for
atleast 50 years and the parties to the marriage are known to the applicant to be deceased.
e. The time periods specified in (38), (3C), and (3D) are waived if the applicant is a descendant or
has been designated to act on behalf of a descendant of the person whose record is being
requested. A descendant is a person in the direct line of descent. The applicant shall provide
documentation of descendancy prior to the release of information in those instances where a
waiver of the waiting period is requested. A party acting on behalf of a descendant shall further
provide documentation that the descendant authorized the party to make such application.
1. All uncertified copies, abstracts, or information issued for genealogical research purposes shall be
clearly marked with the statement "For Genealogical Purposes Only."
4. Genealogy Fee Schedule
Fee schedule per one spelling of name. Fee varies depending on requested number of years to be
searched. Unused fees will be refunded.
1-3 years
4-1 0 years
11-20 years
21-30 years
$22.00
$42.00
$62.00
$82.00
31-40 years
41-50 years
51-60 years
61-70 years
$102.00
$122.00
$142.00
$162.00
DOH-1562 (06/2003)