BIRTH CERTIFICATE REQUEST FORM

The fee is $30.00 for the first certified copy and $15.00 for each additional copy of the same certificate when ordered at the same time.

You must have been born in Onondaga County to obtain your certificate from this office. The only individuals who are able to receive certified copies of birth certificates are those listed on the original certificate (mother, father, child).

Please fill out as many fields as you can, fields marked with a * are required

Certificate Information
First Name: *
Middle Name:
Last Name: *
Date of Birth (MM/DD/YYYY):*
/ /
Place of Birth (e.g. hospital or residence):
Village, Town, or City of Birth  
 
County of Birth:
 
NOTE: You must have been born in Onondaga County to obtain a certificate from this office.
Local Register # (if known):
Father's First Name:
Father's Middle Name:
Father's Last Name:
Mother's First Name: *
Mother's Middle Name:
Mother's Maiden Last Name: *
Certificate Details
Type of certificate Requested (Please Check Appropriate Selection) *
    Certified Copy of Birth: A photostatic copy of the original birth certificate affixed with the raised seal of the Onondaga County Health Department.
    Certification of Birth: An abstract from the original birth certificate stating: name date and place of birth, sex of child, file date and registration number; will have a raised seal of the Onondaga County Health Department.
 
Purpose for Which Record is Required (check one): *
Passport Working Papers Welfare assistance Social Security
Retirement Driver License School Entrance Veteran's benefits
Employment Marriage License Court Proceeding Entrance into Armed Forces
Other (specify)    
Relationship:
Describe your relationship to person whose record is required ( if self, state "self" ): *
If you are an Attorney, the name and relationship of your client to the person whose record is required must be completed.
A copy of your Driver License and Bar Association Card or Unified Court System must be faxed.
Client:
Relationship:
Name and address of Applicant:
Name: *
(exactly as it appears on credit card)
Address: *
Address 2:
City: *
State:
Zip: *
Email: *
Confirm Email: *
Order Information:
Number of Copies Requested:*
 
 Expedited Shipping Options:

Please check here if you would like your order sent by Express Mail (2 to 3 day delivery). An additional $20.00 fee will be charged to your credit card.

Please check here if you would like your order sent by Next Business Day Delivery. An additional $25.00 fee will be charged to your credit card. 

All documentation must be received by noon for same day expedited shipping. Otherwise, the expedited order will be shipped the next business day.

All other orders will be sent by regular U.S. Mail. Please allow 7-10 business days for processing your order.
Total Charge:
Credit Card Information:
Credit Card: *
Expiration Date*
/
Card Number: *
CID
*
 
Card Holder Name: *
Note: Card Holder Name must be the same as Applicant Name.
Billing Address: *
Billing Address 2:
City: *
State:
Zip: *
Daytime Phone: *
Shipping Information:
Name:
Note: Shipping Name must be the same as Applicant Name.
Address: *
Address 2:
City: *
State:
Zip: *
Printing Information:

If you decide to mail this form instead of submitting it on-line, you must sign and date below!
 
Signature: ___________________________________    Date: __________

Attention:
Please check to make sure that your order information is correct before you click the complete order button.

Make sure to click the complete order button only once. Wait for a response from the system. If you click the button more than once, you may be ordering more than once.