LACKAWANNA COUNTY

[Pages:2]LACKAWANNA COUNTY

APPLICATION FOR

BIRTH/DEATH RECORDS

(Birth Records available from 1893 ? 1905) (Death Records available from 1878-1905) *** Excludes Births/Deaths that occurred in the City of Scranton***

Signature of Person making the request:

Signature required on all requests.

PRINT or TYPE your name and address:

Name: Relation to person named on the certificate:

Address:

State:

Zip:

City: Phone:

PRINT or TYPE the information below with regard to the person named on requested certificate.

Number of Copies:

Name at Birth/ Death:

Place of Birth/Death:

Maiden name of Mother:

Full name of Father:

Date of Birth/Death :

Sex: M

F

IMPORTANT: PLEASE NOTE

The fee for Birth and Death Genealogy searches is $ 25.00 per search. All searches are nonrefundable. Please enclose a self-addressed envelope along with a check made payable to the Marriage License Bureau in the applicable amount. Mail requests to:

LINDA MUNLEY Register of Wills Clerk of Orphans' Court The Scranton Electric Building

Suite 400 507 Linden Street

Scranton, PA 18503 570/963-6702

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