Transcription of APPLICATION DATE APPLICATION FOR CERTIFIED …
1 APPLICATION DATECITY OF PHILADELPHIADEPARTMENT OF RECORDSCITY ARCHIVES3101 MARKET STREET philadelphia , PA 19104DO NOT WRITE IN SPACE BELOW OFFICE USE ONLYFULL NAME OF MALE (FIRST) (MIDDLE)(LAST)PLACE OF BIRTH (NUMBER AND STREET) date OF BIRTHYR. MONTH DAYNAME OF ATTENDING PHYSICIAN OR MIDWIFEIF BORN IN HOSPITAL, STATE NAME AND ADDRESSNAME OF FATHERNAME OF MOTHER (FIRST NAME AND MAIDEN NAME)NAME OF APPLICANTADDRESS OF APPLICANTDATE RECEIVED date ANSWERED OR COPY SENT SEARCH MADE BY RECEIPT NUMBERAPPLICATION FORCERTIFIED COPY OF BIRTH RECORDNUMBEROF COPIES_____@ $ Each $ _____TOTAL FEE82-153 (Rev.)
2 9/98)For births during period July 1, 1860 to June 30, 1915. If born after June 30, 1915 Apply Room1009, State Building Broad & Spring Garden EACH APPLICATION AND SEARCH, THE FEE IS $ AND MUST ACCOMPANY THIS FORMIn the event there is no record of birth, a No Record Statement will be issued. The fee of $ for each APPLICATION will becharged for the search and statement. Additional certificates for the same record will be charged $ for CHECKS OR MONEY ORDERS PAYABLE TO : THE CITY OF philadelphia DO NOT SEND CASH OR STAMPSALLOW 6 TO 8 WEEKS FOR CERTIFICATE TO ARRIVENOTE: A dishonored check will require an additional penalty fee of $ (Ordinance of City Council).
3 IT IS MOST IMPORTANT THAT date OF BIRTH BE COMPLETELY FILLED INAPPLICATION DATECITY OF PHILADELPHIADEPARTMENT OF RECORDSCITY ARCHIVES3101 MARKET STREET philadelphia , PA 19104DO NOT WRITE IN SPACE BELOW OFFICE USE ONLYFULL NAME OF MALE (FIRST) (MIDDLE)(LAST)PLACE OF BIRTH (NUMBER AND STREET) date OF BIRTHYR. MONTH DAYNAME OF ATTENDING PHYSICIAN OR MIDWIFEIF BORN IN HOSPITAL, STATE NAME AND ADDRESSNAME OF FATHERNAME OF MOTHER (FIRST NAME AND MAIDEN NAME)NAME OF APPLICANTADDRESS OF APPLICANTDATE RECEIVED date ANSWERED OR COPY SENT SEARCH MADE BY RECEIPT NUMBERAPPLICATION FORCERTIFIED COPY OF BIRTH RECORDNUMBEROF COPIES_____@ $ Each $ _____TOTAL FEE82-153 (Rev.)
4 9/98)For births during period July 1, 1860 to June 30, 1915. If born after June 30, 1915 Apply Room1009, State Building Broad & Spring Garden EACH APPLICATION AND SEARCH, THE FEE IS $ AND MUST ACCOMPANY THIS FORMIn the event there is no record of birth, a No Record Statement will be issued. The fee of $ for each APPLICATION will becharged for the search and statement. Additional certificates for the same record will be charged $ for CHECKS OR MONEY ORDERS PAYABLE TO : THE CITY OF philadelphia DO NOT SEND CASH OR STAMPSALLOW 6 TO 8 WEEKS FOR CERTIFICATE TO ARRIVENOTE: A dishonored check will require an additional penalty fee of $ (Ordinance of City Council).
5 IT IS MOST IMPORTANT THAT date OF BIRTH BE COMPLETELY FILLED IN
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