New Berlin, NY · Chenango County
Death Record Request Application
This application lets a requester seek a copy of a death record or a No Record Certification from the Local Registrar.
What this form is
Use this application to request a copy of a death record or a No Record Certification. It asks for information about the deceased, including their name, date and place of death, and information about the applicant, including their relationship to the deceased, purpose for the request, signature, and address. It also includes fields for the number of copies requested.
Who needs it
Anyone requesting a death record copy or No Record Certification can use this application to provide the required information.
How to submit it
Submit it to the Local Registrar named on the form and enclose the stated $10 fee per copy or No Record Certification. Do not send cash or stamps.
About notarization
This document is signed without a notary; the applicant just signs and dates the application.
How to submit this form
- 1
Download The Application
Download the Death Record Request Application PDF.
- 2
Complete The Application
Print or type the requested information about the deceased and applicant, then sign and date the form.
- 3
Prepare The Fee
Enclose the stated $10 fee per copy or No Record Certification. Do not send cash or stamps.
- 4
Submit To The Local Registrar
Submit the completed application and fee to the Local Registrar named on the form.
Frequently asked questions
- Do I need a notary for the Death Record Request Application?
- No. This document is signed without a notary; the applicant just signs and dates the application.
- How do I submit the Death Record Request Application?
- Submit it to the Local Registrar named on the form and enclose the stated $10 fee per copy or No Record Certification. Do not send cash or stamps.
- What information does the application ask for?
- It asks for details about the deceased, the applicant’s relationship and purpose, the applicant’s signature and address, and the number of copies requested.