What can I request with this application?

The form is for requesting a copy of a death record or a no-record certification. It asks how many copies you want, with or without the confidential cause of death.

What information does the application ask for?

It asks for details about the deceased, the purpose of the request, your relationship to the deceased, your capacity, your signature, date, and address.

Do I need a notary for this death record application?

No. The applicant signs and dates this application without a notary, and the form lists no notarized attachment or related step.

Clarendon, NY · Orleans County

No notary required

Application for Copy of Death Record

Use this application to request a copy of a death record or a no-record certification from the local registrar.

What this form is

This application is for requesting a copy of a death record or a no-record certification. It asks for the deceased person’s identifying details, the applicant’s relationship and purpose, and the number of copies requested with or without the confidential cause of death. The form lists a fee of $10.00 per copy.

Who needs it

Anyone requesting a copy of a death record or a no-record certification from the local registrar can use this application.

How to submit it

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

About notarization

This application is signed without a notary; the applicant signs and dates it, and the form lists no notarized attachment or related step.

How to submit this form

1
Download The Application
Download the death record application PDF.
2
Complete The Request
Enter the requested details about the deceased, your relationship and purpose, and the number of copies requested.
3
Review The Form
The form lists no attachment or notarized step; check that the application is signed and dated.
4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.

Frequently asked questions

What can I request with this application?: The form is for requesting a copy of a death record or a no-record certification. It asks how many copies you want, with or without the confidential cause of death.
What information does the application ask for?: It asks for details about the deceased, the purpose of the request, your relationship to the deceased, your capacity, your signature, date, and address.
Do I need a notary for this death record application?: No. The applicant signs and dates this application without a notary, and the form lists no notarized attachment or related step.
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.

Need something notarized?

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