TOWN OF DUDLEY

VITAL RECORDS REQUEST FORM

 

Date: __________

Type of record(s) and number of copies:

Birth____________ Death __________ Marriage___________

If you are not certain whether a vital record is filed with the Dudley Town Clerk, you are encouraged to call the office for confirmation at (508) 949-8004 prior to mailing your request.

Please Print

TYPE OF RECORD

NAME

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$11.00 Fee for each certified copy ($1.00 goes towards records preservation)

Please submit your request along with proper fees (check or money order only) or you may pay on-line at www.dudleyma.gov

Please make check payable to the Town of Dudley

Please enclose a self-addressed, stamped envelope with this form in order to ensure a rapid response

Restricted Records

A birth record is considered impounded if the parents were not married at the time of the birth. A marriage record is considered impounded if there is a parentís name missing on the certificate. Therefore, these records can only be acquired by an individual whose name appears on the certificate).

In order to obtain a restricted record, you must provide a picture ID (if coming in person).If you are requesting a restricted record through the mail your signature must be witnessed by a Notary Public.

Date: __________________________

 

Signature: ________________________________________________________ †††††††††††††

 

Notary Public: _____________________________________________________

 

Commission Expires: _____________________________

 

Evidence of ID: ___________________________________________________††††††††††††††

 

Seal/Stamp: