Wyoming Death certificate application form

INFORMATION ABOUT THE DECEDENT

DO YOU KNOW THE EXACT DATE WHEN THE DEATH OCCURRED?

Yes

YEAR OF DEATH

DECEDENT FIRST NAME

DECEDENT MIDDLE NAME

DECEDENT LAST NAME

GENDER

Male

Female

HAS THE DECEDENT EVER CHANGED HIS/HER NAME DUE TO A MARRIAGE?

Yes

DATE OF BIRTH

STATE OF DEATH

COUNTY OF DEATH

CITY OF DEATH

YOUR NAME AND CONTACT INFORMATION

Please enter your name and contact information here.

FIRST NAME

MIDDLE NAME

LAST NAME

PHONE NUMBER

EMAIL ADDRESS

CONFIRM EMAIL ADDRESS

RELATIONSHIP TO THE PERSON ON RECORD

WHAT IS YOUR RELATIONSHIP WITH THE PERSON ON THE CERTIFICATE?

WHY ARE YOU APPLYING FOR A DEATH CERTIFICATE?

ADDRESS WHERE YOU WOULD LIKE THE DEATH CERTIFICATE TO BE DELIVERED

STREET

APT, SUITE, FLOOR, ETC.

CITY

STATE

ZIP CODE

By checking this box, I agree to submit the information provided to this website, and I authorize Vital Records Online to use my information to fill all necessary documents in order to prepare my application materials. I understand that VitalRecordsOnline.com is a private document preparation service and that I am hiring them to prepare my birth certificate application materials. I understand there is a service fee charged by VitalRecordsOnline.com and I will pay the health department required fee directly by check or money order. I understand I may have to provide additional documents to the health department in order to prove my identity. By submitting the form above, I agree to these terms and the terms of this website.