Bangor, NY · Franklin County
Mail-In Application for Copy of Death Certificate
This application lets eligible relatives request a copy of a death certificate for a death that occurred in New York State outside New York City.
What this form is
Use this application to request a certified copy of a death certificate for a death that occurred in New York State outside New York City. The applicant must be the deceased’s spouse, parent, child, or sibling, or provide documentation of a lawful right or claim. The form asks for information about the deceased, the applicant’s relationship and contact details, and the reason for the request.
Who needs it
A spouse, parent, child, sibling, or person documenting a lawful right or claim may use this application to request a death certificate copy.
How to submit it
Mail the signed application, required identification and other documentation, and a check or money order to the New York State Department of Health, Vital Records Certification Unit, P.O. Box 2602, Albany, NY 12220-2602.
About notarization
The applicant signs and dates this application without a notary; a notarized statement is required if delivery is to a P.O. Box or third party.
How to submit this form
- 1
Download the Application
Download and print the Mail-In Application for Copy of Death Certificate.
- 2
Complete and Sign
Provide the requested information about the deceased and applicant, then sign and date the application.
- 3
Gather Required Items
Include copies of required identification and, if applicable, documentation of a lawful right or claim, plus a check or money order.
- 4
Mail the Application
Mail the application and required items to the New York State Department of Health Vital Records Certification Unit at the address on the form.
Frequently asked questions
- Do I need a notary for the Mail-In Application for Copy of Death Certificate?
- No. Sign and date the application without a notary. If the record should be sent to a P.O. Box or third party, include a notarized statement signed by the applicant and a copy of the applicant’s driver license.
- How do I submit the death certificate application?
- Mail the signed application, copies of required identification and documentation, and a check or money order to the New York State Department of Health Vital Records Certification Unit, P.O. Box 2602, Albany, NY 12220-2602.
- Who can request a copy using this application?
- The deceased’s spouse, parent, child, or sibling may apply. Other applicants must submit documentation establishing a lawful right or claim, such as a court order or an official letter.
- What payment does the application require?
- The fee is $30 per copy. Pay by check or money order to the New York State Department of Health; do not send cash. The fee is not refunded if no record is on file.