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, call the office for confirmation at (508) 949-8004 before ordering

Please Print

NAME

DATE

$10.00 Fee for each certified copies (birth certificate, marriage cert., and death cert.)

Other: _________________________________________________________________

Please submit your request along with proper fees (cash or check only)

Checks can be made payable to the Town of Dudley

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

Impounded 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 parent’s name missing on the certificate. Therefore, these records can only be acquired by an individual whose name appears on the certificates).

If trying to obtain an impounded record, you must provide a picture ID (if coming in person), or have your signature notarized on this request form.