Black Brook, NY · Clinton County
Death Record Copy Application
This application lets someone request a copy of a deceased person's death record from the Local Registrar and provide details about the deceased and the request.
What this form is
Use this application to request copies 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 parents’ names, as well as the applicant’s relationship to the deceased, purpose for the request, address, and requested number of copies. The form lists a $10 fee per copy.
Who needs it
Anyone requesting a copy of a death record or a no-record certification from the Local Registrar should complete this application.
How to submit it
Submit it to the Local Registrar; do not send cash or stamps. The form lists a $10 fee per copy.
About notarization
This document is signed and dated without a notary; the form lists no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Application
Download the Death Record Copy Application.
- 2
Complete The Form
Enter the requested details about the deceased, your relationship and purpose, your address, and the number of copies.
- 3
Prepare The Fee
The form lists a $10 fee per copy. Do not send cash or stamps.
- 4
Submit To The Local Registrar
Submit the completed application to the Local Registrar.
Frequently asked questions
- Do I need a notary for the Death Record Copy Application?
- No. The application is signed and dated without a notary, and it lists no notarized or sworn attachment.
- How do I submit the Death Record Copy Application?
- Submit it to the Local Registrar. Do not send cash or stamps; the form lists a $10 fee per copy.
- What information does the application ask for?
- It asks for details about the deceased, the purpose of the request, the applicant’s relationship and address, and the number of copies requested.
- Can I request a no-record certification?
- Yes. The form lists a no-record certification as an option and states a fee of $10 per copy or certification.