Do I need a notary for the Application for Copy of Certified Death Record?

No. This application is signed and dated without a notary. It requires identification and, for some applicants, documentation of a lawful right or claim.

What identification must I include?

Include a copy of one valid photo ID, or copies of two utility or telephone bills or government agency letters dated within the last six months that show your name and address.

Who must provide documentation of a lawful right or claim?

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

Nyack, NY · Rockland County

No notary required

Application for Copy of Certified Death Record

This application lets eligible applicants request a certified death record copy from Nyack’s local registrar and provide identification and eligibility documentation.

At a glance

Issued by: City of Nyack · Nyack, Rockland County, New York
Notarization: Not required: file this form without a notary.
Official source: nyack.gov
Blank form: Download the PDF
Catalogued: Sep 28, 2026
Machine-readable: JSON record · about the forms index

What this form is

Use this application to request a copy of a death record from the local registrar. It asks for details about the deceased, the applicant’s relationship and purpose, the number of copies requested, and the applicant’s contact information. Applicants must include copies of qualifying photo identification or two documents showing their name and address; people who are not a parent, child, or spouse at the time of death must also submit documentation of a lawful right or claim.

Who needs it

Anyone requesting a certified death record copy from Nyack’s local registrar should complete this application and provide the required identification.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details. The form lists a fee of $10 per certified copy for other districts.

About notarization

This document is signed and dated without a notary; it asks the signer to provide identification and, when applicable, documentation of a lawful right or claim.

How to submit this form

1
Download The Application
Download the Application for Copy of Certified Death Record PDF.
2
Complete The Application
Enter the deceased’s information, your relationship and purpose, the number of copies requested, and your contact details.
3
Gather Supporting Documents
Include the required copies of identification and, if applicable, documentation of a lawful right or claim.
4
Submit To The City
Submit the application to the city department named on the form; check the city website for current contact details.

Frequently asked questions

Do I need a notary for the Application for Copy of Certified Death Record?: No. This application is signed and dated without a notary. It requires identification and, for some applicants, documentation of a lawful right or claim.
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. The form lists a fee of $10 per certified copy for other districts.
What identification must I include?: Include a copy of one valid photo ID, or copies of two utility or telephone bills or government agency letters dated within the last six months that show your name and address.
Who must provide documentation of a lawful right or claim?: Applicants who are not the deceased’s parent or child, or the deceased’s spouse at the time of death, must submit documentation of a lawful right or claim.

Need something notarized?

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