California Department of Public Health - Vital Records · California state form
VS 112 Application for Certified Copy of Death Record
Use VS 112 to request an authorized or informational certified copy of a California death record from the Department of Public Health – Vital Records.
- What this form is
- VS 112 is the application for requesting a certified copy of a death record. Applicants select an authorized copy or an informational copy, provide details about the registrant and applicant, and state the number of copies requested. Authorized copy requests generally require a notarized sworn statement; informational copy requests do not. The instructions specify a $26 fee per copy and explain how to submit the application.
- Who needs it
- People requesting a certified copy of a California death record may use this application; only eligible authorized persons can receive an authorized copy.
- Why it needs a notary
- Authorized copy requests generally require a notarized sworn statement; law enforcement, government agencies, and funeral establishments are exempt. Informational copy requests need no sworn statement.
- How to submit it
- Complete the application and mail it with the required fee to CDPH-VR at the address printed on the form. Include a notarized sworn statement for an authorized copy, if applicable.
Questions
Who can request an authorized copy of a death record?
The form lists eligible relationships and representatives, including certain family members, government agency representatives, attorneys, and funeral establishment employees acting within the specified scope.
Is a notary needed for the VS 112 application?
An authorized copy request generally requires a notarized sworn statement. The form exempts law enforcement, governmental agencies, and funeral establishments from notarization, but they must complete the statement page. Informational copy requests do not require a sworn statement.
How do I submit VS 112?
Mail the completed application and payment to CDPH-VR at the address printed in the instructions. The form specifies a check or money order in U.S. dollars for each copy and says not to send cash.