Birth and Death Certificate

Applications for Birth and Death Certificates

TO: APPLICANT

FROM: REGISTRAR'S OFFICE

RE: APPLICATION FOR CERTIFICATE OF BIRTH OR DEATH

Please complete the enclosed form in its entirety and attach a copy of one of the eight acceptable forms of identification.

Return form and required ID to:

VILLAGE OF MEDINA REGISTRAR
119 PARK AVENUE
MEDINA, NY 14103

Include a money order for $10.00 to cover the cost of the certificate. Checks will NOT be accepted. MONEY ORDER ONLY
© 2013 Village Of Medina, Orleans County