Deerpark, NY · Orange County
Application for Copy of Death Record
This application lets a person request a copy of a death record or a no-record certification from Deerpark’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, including name, date of death, parents’ names, Social Security number, birth information, and place of death. Applicants also provide the purpose for the request, their relationship to the deceased, requested copy details, contact information, and a signature and date.
Who needs it
Anyone requesting a death record copy or no-record certification from the Local Registrar can use this application.
How to submit it
Submit the application to the Local Registrar named on the form; check the city website for current contact details. The form lists a $10 fee per copy or no-record certification and says not to send cash or stamps.
About notarization
This application is signed and dated without a notary; no notarized or sworn attachment is identified, so the applicant just signs and dates it.
How to submit this form
- 1
Download The Application
Download the death record application PDF.
- 2
Complete The Request
Provide the requested details about the deceased, your relationship and purpose, and your contact information.
- 3
Choose Copy Details
Enter the number of copies requested with or without confidential cause of death.
- 4
Sign And Submit
Sign and date the application, then submit it to the Local Registrar named on the form. Do not send cash or stamps.
Frequently asked questions
- Do I need a notary for the death record application?
- No. This application is signed and dated without a notary, and it identifies no notarized or sworn attachment.
- How do I submit the death record application?
- Submit it to the Local Registrar named on the form. The document provides no address or other contact details, so check the city website for current information.
- What information does the application ask for?
- It asks for information about the deceased, the applicant’s relationship and purpose, contact details, and the number and type of copies requested.
- What fee does the form list?
- The form lists $10 per copy or no-record certification and says not to send cash or stamps.
Need something notarized?
This Application for Copy of Death Record doesn’t need a notary — but if you have another Deerpark form that does, a commissioned online notary can help.