Brookfield, NY · Madison County
Death Record Request Form
This application lets a person request a copy of a death record or a no-record certification from Brookfield’s local registrar.
What this form is
Use this application to request a copy of a death record or a no-record certification. It asks for details about the deceased, the applicant’s relationship and purpose, and where the record should be sent. The form states a fee of $10 per copy or no-record certification and includes separate fields for copies with or without the confidential cause of death for deaths occurring as of January 1, 1988.
Who needs it
Anyone requesting a death record copy or no-record certification from Brookfield’s local registrar should complete this application.
How to submit it
Complete the form and enclose the fee of $10 per copy or no-record certification; do not send cash or stamps. Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed and dated without a notary; it mentions no notarized or sworn attachment, so the applicant just signs and dates it.
How to submit this form
- 1
Download The Form
Download the Death Record Request Form PDF.
- 2
Complete The Application
Print or type the requested details about the deceased, your relationship and purpose, and the mailing address.
- 3
Prepare The Fee
Enclose $10 per copy or no-record certification. Do not send cash or stamps.
- 4
Submit The Form
Submit the completed form to the city department named on it; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Death Record Request Form?
- No. The applicant signs and dates this form without a notary, and the document does not mention a notarized or sworn attachment.
- How do I submit the Death Record Request Form?
- Complete the form and enclose the fee. Do not send cash or stamps. The form does not give a submission address, so check the city website for current contact details.
- What does the death record request form ask for?
- It asks for information about the deceased, the applicant’s relationship and purpose, and the name and address where the record should be sent.
- What is the fee listed on the form?
- The form lists a fee of $10 per copy or no-record certification and says not to send cash or stamps.
Need something notarized?
This Death Record Request Form doesn’t need a notary — but if you have another Brookfield form that does, a commissioned online notary can help.