What identification must I include?

Include copies of either one listed form of valid photo ID or two listed documents showing your name and address, such as utility bills or a government agency letter dated within the last six months.

Who must provide documentation of a lawful right or claim?

Applicants who are not the deceased’s parent, child, or spouse at the time of death must submit documentation of a lawful right or claim.

Theresa, NY · Jefferson County

No notary required

Application for Copy of Death Record

This application lets eligible people request a certified copy of a death record or a no-record certification from the local registrar.

What this form is

Use this application to request copies of a death record or a no-record certification. It asks for information about the deceased, the applicant’s relationship and purpose, and the number and type of copies requested. Include copies of the required identification; applicants who are not the deceased’s parent, child, or spouse at the time of death must also provide documentation of a lawful right or claim.

Who needs it

People requesting a death record copy or no-record certification should complete the application and provide the identification and supporting documentation it requires.

How to submit it

Submit the application to the local registrar; check the city website for current contact details.

About notarization

This document is signed and dated without a notary; attach copies of the required identification and, if applicable, documentation of a lawful right or claim.

How to submit this form

1
Download The Application
Download the death record copy application PDF.
2
Complete The Application
Provide details about the deceased, your relationship and purpose, and the number and type of copies requested.
3
Gather Required Documents
Attach copies of the required identification and, if applicable, documentation of a lawful right or claim.
4
Sign And Submit
Sign and date the application, then submit it to the local registrar.

Frequently asked questions

Do I need a notary for the death record copy application?: No. The application asks you to sign and date it without a notary. Attach copies of the required identification and, if applicable, documentation of a lawful right or claim.
How do I submit the death record copy application?: Submit the completed application to the local registrar. Check the city website for current contact details.
What identification must I include?: Include copies of either one listed form of valid photo ID or two listed documents showing your name and address, such as utility bills or a government agency letter dated within the last six months.
Who must provide documentation of a lawful right or claim?: Applicants who are not the deceased’s parent, child, or spouse at the time of death must submit documentation of a lawful right or claim.

Need something notarized?

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