Chestnut Ridge, NY · Rockland County
Application for Copy of Death Record
This application lets eligible people request a copy of a death record from the local registrar by providing information about the deceased, their relationship, and the requested copies.
What this form is
Use this application to request a copy of a death record or a no-record certification from the local registrar. It asks for details about the deceased, the applicant’s relationship and capacity, the purpose of the request, and the number of copies requested, with or without confidential cause of death. The form lists who may receive a copy and states a fee of $10 per copy or certification.
Who needs it
A person seeking a death record copy or no-record certification who meets one of the access categories listed on the form should complete this application.
How to submit it
Submit the application to the local registrar. The form states a fee of $10 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; the form does not identify any notarized or sworn attachment.
How to submit this form
- 1
Download The Application
Download the Application for Copy of Death Record PDF.
- 2
Complete The Application
Enter the deceased’s details, your relationship and capacity, the purpose of the request, and the number of copies requested.
- 3
Review The Access Categories
Check the listed categories for release of death record copies and confirm the form’s fee information.
- 4
Submit To The Local Registrar
Send the completed application to the local registrar. Do not send cash or stamps.
Frequently asked questions
- Who can request a copy of a death record?
- The form lists eligible requesters, including specified family members, their lawful representatives, people with documented legal rights or medical needs, and agencies requesting records for official purposes.
- What information does the application ask for?
- It asks for details about the deceased and applicant, the purpose and relationship, and the number of copies requested with or without confidential cause of death.
- Do I need a notary for the Application for Copy of Death Record?
- No. The application is signed and dated without a notary, and the form does not identify any notarized or sworn attachment.
- How do I submit the Application for Copy of Death Record?
- Submit it to the local registrar. The form states a fee of $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 Chestnut Ridge form that does, a commissioned online notary can help.