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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