Roxbury, NY · Delaware County
Application to Local Registrar for Copy of Death Record
This application lets a person request a death record copy or No Record Certification from the local registrar using information about the deceased.
What this form is
Use this application to request a copy of a death record or a No Record Certification from the local registrar. It asks for details about the deceased, the applicant’s relationship and purpose, and where the record should be sent. For deaths occurring as of January 1, 1988, it also asks how many copies are requested with or without the confidential cause of death.
Who needs it
Anyone requesting a death record copy or No Record Certification from the local registrar can use this application.
How to submit it
Complete the form and enclose the $10.00 fee per copy or No Record Certification; do not send cash or stamps. The application is addressed to the local registrar.
About notarization
This application is signed and dated without a notary; it does not identify any notarized attachment or sworn step.
How to submit this form
- 1
Download The Application
Download the death record copy application PDF.
- 2
Complete The Form
Print or type the requested information about the deceased, applicant, purpose, and mailing address.
- 3
Enclose The Fee
Include $10.00 per copy or No Record Certification. Do not send cash or stamps.
- 4
Submit To The Local Registrar
Send the completed application and fee to the local registrar.
Frequently asked questions
- Do I need a notary for the death record copy application?
- No. This application is signed and dated without a notary, and it does not identify any notarized attachment or sworn step.
- How do I submit the death record application?
- Complete the form and enclose $10.00 per copy or No Record Certification. Do not send cash or stamps; the application is addressed to the local registrar.
- What information does the application request?
- It asks for information about the deceased, the applicant’s relationship and purpose, and the address where the record should be sent.
- How much is the fee?
- The form states a fee of $10.00 per copy or No Record Certification and says not to send cash or stamps.
Need something notarized?
This Application to Local Registrar for Copy of Death Record doesn’t need a notary — but if you have another Roxbury form that does, a commissioned online notary can help.