What does the death record application ask for?

It asks for information about the deceased, the record and copies requested, the applicant’s purpose and relationship, and the applicant’s contact information and signature.

What identification must I provide?

The form requires copies of either one listed valid photo ID or two listed documents showing the applicant’s name and address.

Do I need a notary for the death record application?

No. This document is signed without a notary, and it mentions no notarized or sworn attachment; the signer just signs and dates it.

Philadelphia, NY · Jefferson County

No notary required

Application for Copy of Death Record

This application requests a copy of a death record from the local registrar and is completed by the person seeking the record.

What this form is

Use this application to request a copy of a death record from the local registrar. It asks for details about the deceased, the requested record and number of copies, the applicant’s purpose and relationship to the deceased, and the applicant’s contact information and signature. The application requires copies of identification documents listed on the form.

Who needs it

Anyone requesting a copy of a death record should complete this application and provide the identification copies required by the form.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details and submission requirements.

About notarization

This document is signed without a notary; it mentions 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 Application
Enter the requested information about the deceased, the record, and yourself.
3
Gather Identification Copies
Include copies of either one listed valid photo ID or two listed documents showing your name and address.
4
Sign And Submit
Sign the application and submit it to the city department named on the form.

Frequently asked questions

What does the death record application ask for?: It asks for information about the deceased, the record and copies requested, the applicant’s purpose and relationship, and the applicant’s contact information and signature.
What identification must I provide?: The form requires copies of either one listed valid photo ID or two listed documents showing the applicant’s name and address.
Do I need a notary for the death record application?: No. This document is signed without a notary, and it mentions no notarized or sworn attachment; the signer just signs and dates it.
How do I submit the death record application?: Submit it to the city department named on the form; check the city website for current contact details and submission requirements.

Need something notarized?

This Application for Copy of Death Record doesn’t need a notary — but if you have another Philadelphia form that does, a commissioned online notary can help.