Town Hall
10 Mudge Way
Bedford, Mass. 01730
781-275-0083

Please send in a self-addressed, stamped envelope with your vital records request form.

BIRTH

Long Form $10.00

Paid:_______

Due:__________
Name:_______________________ How many copies:_______________
Date of Birth:__________ Record No:____________________
Will Pick up:____________________ Mail to:_____________________

MARRIAGE

Long Form $10.00

Paid:______

Due:_________
Name of Groom:_________________ How many copies:____________
Name of Bride:__________________
Date of Marriage:_________ Record No:________________
Will Pick up:_______________ Mail to:___________________

DEATH

Long Form $10.00

Paid:______

Due:__________
Name of Deceased:_______________ How many copies:________________
Date of Death:_________ Record No:__________________
Will Pick up:____________________ Mail to:____________________