Application for Certified Copy of Death Record (VS 112)

Who can use this form

• A parent, legal guardian, child, grandparent, grandchild, sibling, spouse or domestic partner of the person who died
• Surviving next of kin, a funeral establishment acting for the family, or an attorney or court-appointed representative of the estate
• A law enforcement or government agency on official business
• Anyone else can order a certified informational copy, marked "not a valid document to establish identity"

What to send with it

• This application, one per death record
• The sworn statement on page 5, signed in front of a notary public, for an authorized copy
• A check or money order for $26 per copy, payable to CDPH-Vital Records (no cash)

Where to send it

Mail to

California Department of Public Health Vital Records – MS 5103 P.O. Box 997410 Sacramento, CA 95899-7410

State fee

$26 per certified copy. Kept as a search fee if no record is found.

Typical processing

About 4 to 6 weeks after CDPH receives the request; the county of death is often faster

Source

Official government page