Bergen, NY · Genesee County
Application for a Copy of Death Record
This application is for people requesting a copy of a death record from the local registrar and asks for information about the deceased, the applicant, and the request.
What this form is
Use this application to request a copy of a death record or a No Record Certification. It asks for the deceased’s identifying details, the number of copies and purpose for the request, and the applicant’s relationship and contact information. The application requires copies of specified identification, and applicants who are not a parent, child, or spouse must provide documentation of a lawful right or claim.
Who needs it
Anyone requesting a copy of a death record or No Record Certification must complete the application and provide the required identification.
How to submit it
Submit the application to the local registrar with copies of the required identification; the form lists a $10 fee per certified copy or No Record Certification for other districts.
About notarization
This application is signed and dated without a notary; include identification copies and, if applicable, documentation of a lawful right or claim.
How to submit this form
- 1
Download The Application
Download the Application for a Copy of Death Record PDF.
- 2
Complete The Application
Enter the deceased’s details, the number of copies requested, the purpose, your relationship, and your information.
- 3
Gather Required Documents
Include copies of either one listed valid photo ID or two listed documents showing your name and address; add lawful-right documentation if applicable.
- 4
Submit To The Local Registrar
Submit the application and identification copies to the local registrar. The form lists the fee for other districts.
Frequently asked questions
- Do I need a notary for the Application for a Copy of Death Record?
- No. The application has a signature and date line but no notary block. Include identification copies and, if applicable, documentation of a lawful right or claim.
- How do I submit the death record application?
- Submit the application to the local registrar with copies of the required identification. The form lists a $10 fee per certified copy or No Record Certification for other districts.
- What identification must I include?
- Include either one listed form of valid photo identification or two listed documents showing your name and address, such as utility bills or a government letter dated within the last six months.
- Who must provide proof of a lawful right or claim?
- Applicants who are not the deceased’s parent or child, or the deceased’s spouse at the time of death, must submit documentation of a lawful right or claim.