Alabama Application to Change a Death Certificate (ADPH-HS-33)

Who can use this form

• The funeral home, the informant, an immediate family member listed on the record, or others with an appropriate legal interest.
• This form covers personal and demographic information only.
• Only the certifier who signed the death certificate may change the medical certification or the date or time of death. This form cannot be used for those items.
• By signing, the applicant certifies a legal right to the record. Only one request may be made per form.

What to send with it

• The completed form showing the changes to be made, with the applicant section signed.
• Valid identification. The ID requirements are printed on the back of the form.
• Legal documentation or a court order may be required to process the amendment.
• The $20 amendment fee. A check or money order payable to "Center for Health Statistics". Do not send cash.
• The original information on the death certificate is not changed. The amendment is an affidavit issued with the original certificate that shows the corrected items.

Where to send it

Mail to

Center for Health Statistics P.O. Box 5625 Montgomery, Alabama 36103-5625

State fee

$20 to amend a death certificate, including one certified copy of the certificate. Additional copies of the same record ordered at the same time are $6 each. Expediting costs $15 more. Fees are non-refundable.

Typical processing

Not provided

Form revision

Rev. 10/2024

Source

Official government page