Michigan Death Certificate Application (Form DCH-0569-DX) (DCH-0569-DX)
Official state formForm DCH-0569-DXFree downloadLast verified November 9, 2026
Form DCH-0569-DX is used to order a certified copy of a Michigan death record from the Michigan Department of Health and Human Services (MDHHS), Vital Records.
Who can use this form
- Anyone may request a Michigan death record
- No proof of relationship to the deceased is required
What to send with it
- The completed application, signed by hand in ink
- The decedent's name and year of death (required to search)
- Your choice of short form or long form record
- The fee by check or money order payable to State of Michigan
Where to send it
- Mail to
- Vital Records Requests P.O. Box 30721 Lansing, MI 48909
- State fee
- $34 for the first copy, $16 for each additional copy
- Typical processing
- About 10 to 12 weeks by mail
- Source
- Official government page