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CITY OF LEWISTON, MAINE APPLICATION FOR A CERTIFIED COPY OF A BIRTH RECORD $15.00 for first copy, $6.00 for each additional copy of the same record purchased at the same time MUST INCLUDE A PHOTOCOPY OF A GOVERNMENT ISSUED PHOTO I.D. Make check or money order payable to “City of Lewiston” if mailing in your request. **PLEASE PRINT** Full Name on Birth Record: City of Birth: Date of Birth: Parent A Full Name: Parent B Full Name: Your Name: Today’s Date: Your Complete Mailing Address: Email: Your Phone Number: Your Relationship: ☐ Self ☐ Parent ☐ Other (lineage proof required) By signing below, I swear/affirm that the information above is true and correct. Your Signature: How many certified copies? MAIL REQUEST TO: City Clerk’s Office, 27 Pine Street, Lewiston, ME 04240 **PLEASE INCLUDE A SELF ADDRESSED STAMPED ENVELOPE IF MAILNG REQUEST** MUST INCLUDE A PHOTOCOPY OF A GOVERNMENT ISSUED PHOTO I.D. Please note a 2.5% processing fee will be added to all debit & credit card purchases A $1.00 minimum fee will be charged for all debit and credit card transactions EMAIL REQUEST TO: [EMAIL REDACTED] FAX NUMBER: (207) 777-4621 If you are faxing or emailing your request please include the following: Signature of cardholder Name as it appears on the credit card Credit Card Exp. Date 3-digit Security Code Billing Zip Code