New York Direct Line Descendant Application for Copy of Pre-Adoption Birth Certificate (DOH-5300)

Who can use this form

• A direct line descendant (child, grandchild, great-grandchild and so on) of an adoptee born in New York State outside New York City.
• The adoptee must be deceased.
• Adoptees seeking their own record use the Adoptee Application (DOH-5299) instead.
• Do not use it if the birth occurred within the five boroughs of New York City.

What to send with it

• The completed and signed application, filled in with the adoptee's name and adoptive parents' names as listed on the most recent (post-adoption) birth certificate.
• A photocopy of the adoptee's death certificate.
• Photocopies of records showing the line of descent from the adoptee to you, such as birth and death records, plus marriage records or name change orders if any names changed.
• 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.
• 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