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LACKAWANNA COUNTY APPLICATION FOR
BIRTH/DEATH RECORDS (Birth Records available from 1893 ? 1905) (Death Records available from 1893-1905) *** 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:______________________________________ City:_____________________
State:__________ Zip:____________ 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 non-refundable.
Please enclose a self-addressed envelope along with a check made payable to the Marriage License Bureau in the applicable amount. Mail requests to:
FRANCES KOVALESKI
Register of Wills Clerk of Orphans' Court 123 Wyoming Ave, Suite 521
Scranton, PA 18503 570-963-6702
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