New York Adoptee Application for Copy of Pre-Adoption Birth Certificate (DOH-5299)

Who can use this form

• A person who was adopted and wants a copy of their own pre-adoption birth certificate. The adoptee must complete and sign the application.
• Do not use it if the birth occurred within the five boroughs of New York City.
• Do not use it to request a current (post-adoption) birth certificate for official use, such as a passport or driver license.

What to send with it

• The completed application, filled in with your adopted name and your adoptive parents' names as they appear on your current (post-adoption) birth certificate.
• A photocopy of one unexpired ID with photo and signature (driver license, state non-driver ID, passport or other government photo ID), or two original documents dated within the last six months showing your current name and address (utility bill, telephone bill, government agency letter).
• A check or money order for $45 per copy payable to the New York State Department of Health. Do not send cash.
• A photocopy of your current (post-adoption) birth certificate, if available.
• If delivery is to a P.O. Box or a third party: a notarized statement signed by the applicant and a copy of the applicant's government issued identification.

Where to send it

Mail to

New York State Department of Health Bureau of Vital Records, PAC Unit PO Box 2602 Albany, NY 12220-2602

State fee

$45 per copy. If no adoption is on file, a notification of no record is sent instead of a birth certificate and the fee is not refunded.

Typical processing

Not provided

Form revision

1/20

Source

Official government page