Request for certified copy of death record

This request form may be completed to purchase copies of a death certificate. If you are requesting an authorized copy, you must be an authorized party, and the Sworn Statement and Certificate of Acknowledgment must have original signatures before it is submitted.

There are two ways to submit the form:

1. Print and submit a completed form: Click the “Preview PDF” button at the bottom of the form to print it, sign it, and submit in person or by mail.
2. Print and complete by hand: Print a blank PDF version of the form, fill it out manually, and submit it in person or by mail.