Rush Notary

Alexandria, NY · Jefferson County

No notary required

Application to Local Registrar for Copy of Death Record

This application lets a person request a copy of a death record from the Alexandria Town Clerk by providing details about the deceased and the applicant.

What this form is

Use this application to request a death record copy or a No Record Certification from the local registrar. The form asks for details about the deceased, the applicant’s relationship and capacity, the purpose of the request, and where the record should be sent. It also asks applicants to specify whether they want copies 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 should complete this application.

How to submit it

Submit the completed form to the Town Clerk and enclose the $10.00 fee per copy or No Record Certification. The form says not to send cash or stamps.

About notarization

This application is signed and dated without a notary; the form lists no notarized attachment or sworn step.

How to submit this form

  1. 1

    Download The Application

    Download the Application to Local Registrar for Copy of Death Record.

  2. 2

    Complete The Form

    Print or type the requested information about the deceased, yourself, the request, and where the record should be sent.

  3. 3

    Enclose The Fee

    Enclose $10.00 per copy or No Record Certification. Do not send cash or stamps.

  4. 4

    Submit To The Town Clerk

    Submit the completed application to the Town Clerk.

Frequently asked questions

What does the death record application request?
It requests details about the deceased and applicant, the purpose and relationship, the destination address, and the number and type of copies.
Do I need a notary for the death record application?
No. This application is signed and dated without a notary, and it lists no notarized attachment or sworn step.
How do I submit the death record application?
Submit the completed form to the Town Clerk and enclose the listed $10.00 fee per copy or No Record Certification. Do not 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 Alexandria form that does, a commissioned online notary can help.