Information about the decedent

1.1 Do you know the exact date when the death occurred?

Yes

1.2. Year of death

2.1 Decedent first name

2.2 Decedent middle name

2.3 Decedent last name

2.4 Gender

Male

Female

2.5 Has the decedent ever changed his/her name due to a marriage?

Yes

3. Date of birth

4.1 State of death

4.2 County of death

4.3 City of death

Your name and contact information

Please enter your name and contact information here.

5.1 First name

5.2 Middle name

5.3 Last name

5.4 Email address

5.5 Confirm email address

5.6 Phone number

Relationship with the decedent

6. What is your relationship with the person on the certificate?

7. Why are you applying for a death certificate?

Address where you would like the death certificate to be delivered

8.1 Street

8.2 Apt, suite, floor, etc.

8.3 City

8.4 State

8.5 Zip code

Agreement and Privacy Policy

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 death 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.