Pennsylvania Request to Amend a Death Record (HD002191)
Official state formCorrections and amendmentsForm HD002191Free downloadLast verified November 10, 2026
Asks the Pennsylvania Department of Health to amend the demographic part of a death record filed in Pennsylvania. After the amendment, the requester is notified and can apply for an updated death certificate. Mail it to the Death Registry in Harrisburg.
Who can use this form
- The informant listed on the original Report of Death
- A person who has obtained a court order to amend the record
What to send with it
- Completed form
- Documents that support each item being changed, such as the decedent's birth certificate, driver's license, Social Security card, DD-214 or divorce decree
- If amending by court order: the certified or original court order and a copy of the petition
- Photocopy of a valid government-issued photo ID, or two current documents that show your name and address
- Notarized signature, unless a certified court order is sent
Where to send it
- Mail to
- Pa. Department of Health Bureau of Health Statistics and Registries ATTN: Death Registry 555 Walnut St., 6th Floor Harrisburg, PA 17101-1934
- State fee
- Not provided
- Typical processing
- Approximately 8 weeks; suspended requests take approximately 12 weeks
- Form revision
- REV 07/20
- Source
- Official government page