Randolph County, IL · Randolph County
Death Request Form
Use this form to request copies of a death certificate from the Randolph County Clerk and provide applicant and death information.
At a glance
- Issued by
- City of Randolph County · Randolph County, Randolph County, Illinois
- Notarization
- Not required: file this form without a notary.
- Official source
- randolphcountyil.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The Death Request Form is used to request copies of a death certificate from the Randolph County Clerk. It asks for the applicant’s name, address, phone number, relationship to the person on the certificate, and the deceased person’s name, date and place of death. The applicant also states the number of copies and intended use, includes a photocopy of current identification, and signs the form.
Who needs it
A person requesting a death certificate copy from the Randolph County Clerk should complete this form and include a photocopy of current identification.
How to submit it
Mail the application and a photocopy of current identification to Randolph County Clerk, #1 Taylor Street, Room 202, Chester, IL 62233. The form lists (618) 826-5000 x191.
About notarization
This form is signed without a notary; no sworn or notarized attachment is mentioned, so the applicant just signs it.
How to submit this form
- 1
Download the Form
Download the Death Request Form.
- 2
Complete the Form
Enter the applicant’s contact details, relationship to the person on the certificate, death information, number of copies, and intended use.
- 3
Gather Identification
Include a photocopy of current identification, as required by the form.
- 4
Mail the Request
Mail the signed application and identification photocopy to the Randolph County Clerk at the address listed on the form.
Frequently asked questions
- What information does the Death Request Form ask for?
- It asks for applicant contact details and relationship to the person on the certificate, death information, the number of copies, and the certificate’s intended use.
- What should I include with the request?
- The form says the request must include a photocopy of current identification.
- Do I need a notary for the Death Request Form?
- No. The form has an applicant signature line but no notary block. No sworn or notarized attachment is mentioned; the applicant just signs the form.
- How do I submit the Death Request Form?
- Mail the application and a photocopy of current identification to Randolph County Clerk, #1 Taylor Street, Room 202, Chester, IL 62233.