Wisconsin Report of Court Order to Amend a Death Record (F-05092)
Official state formCorrections and amendmentsForm F-05092Free downloadLast verified November 14, 2026
Reports a court order that corrects a Wisconsin death record more than one year after the death. The clerk of court completes and seals Part IV, then the form goes to the Wisconsin State Vital Records Office with the fee.
Who can use this form
- A person correcting a death record, after the circuit court in the county where the death occurred grants the petition.
- The clerk of court must complete and seal Part IV before the form is returned to the office.
- For corrections made more than one year after the death.
What to send with it
- The completed, signed and sealed form.
- A check or money order payable to State of Wis. Vital Records.
- A current certified copy of the death record, which the form says to gather with the evidence for the court.
- Fees listed on the form: $10 to file and $20 for one certified copy (fact of death or extended), with $3 for each additional copy.
Where to send it
- Mail to
- State Vital Records Office ATTN: PSSU PO Box 309 Madison, WI 53701-0309
- State fee
- $10 filing fee; one certified copy (fact of death or extended fact of death) $20; each additional copy $3. All as printed on the form.
- Typical processing
- Not provided
- Form revision
- 09/2024
- Source
- Official government page