Death Certificate Application

Request your official Death Certificate by Mail from Home

Death information of the person on record

Please enter the Death information of the individual who needs the Death certificate. If you are applying for someone else (i.e. your child), enter their Death information here.

1.1 First Name at Death

1.2 Middle Name at Death

1.3 Last name at Death

Suffix

1.4 Gender

Male

Female

1.5 Has the person on record ever changed his/her name through a marriage?

Yes

1.6 Has the person on record ever changed his/her name by court order?

Yes

2.1 Date of Death

2.2 State of Death

2.4 City of Death

Information about the parents of the person on record

Mother's first name

Mother's middle name

Mother's last name before any marriage (maiden name)

Mother's last name after marriage if different

Father unknown or not listed on the Death certificate

Yes

Father's first name

Father's middle name

Father's last name

Suffix

Your name and contact information

Whether you are seeking to apply for your Death certificate or are submitting an application for another person (i.e. your child or spouse), please enter your name and contact information here.

First name

Middle name

Last name

Phone number

Email address

Confirm email address

Relationship to the person on record

What is your relationship with the person on the certificate?

Why are you applying for a Death certificate?

Address where you would like the Death certificate to be delivered

Street

Apt, suite, floor, etc.

City

State

Zip Code

By checking this box, I agree to submit the information provided to this website, and I authorize Express Vitals to use my information to fill all necessary documents in order to prepare my application materials. I understand that ukcertificates.uk is a private document preparation service and that I am hiring them to prepare my Death certificate application materials. I understand there is a service fee charged by ukcertificates.uk and I will pay the health department required fee directly by check or money order. I understand I may have to provide additional documents or notarized documents to the health department in order to prove my identity. I understand that I may receive newsletters from Express Vitals. By submitting the form above, I agree to these terms and the terms of this website.