Who can complete this correction application?

The instructions say the form should be completed and signed by the physician who signed the original death certificate or the person who furnished information for it.

What supporting evidence should I include?

Documentary evidence is required for most corrections, but not for certain additions, minor spelling changes, or a date-of-birth change of one year or less. The evidence must identify the certificate and verify the correction.

How do I submit the correction application?

Return it to the Registrar of Vital Statistics for your local area or mail it to the Correction Unit, Vital Records Section, P.O. Box 2602, Albany, NY 12220-2602. Include evidence when required.

Nyack, NY · Rockland County

No notary required

Application for Correction of Death Certificate

This form requests a correction or addition to a death certificate and is completed by the physician who signed it or the person who supplied its original information.

What this form is

Use this form to correct information entered in error or add information omitted when the original death certificate was filed. The application asks for the deceased’s identifying details, the information as recorded and as it should appear, the reason for the change, supporting evidence when required, and the applicant’s signature and relationship to the deceased. Some corrections require documentary evidence; others do not.

Who needs it

The physician who signed the original death certificate or the person who furnished information for it should complete and sign this form.

How to submit it

Return the form to the Registrar of Vital Statistics for your local area or the Correction Unit, Vital Records Section, P.O. Box 2602, Albany, NY 12220-2602. Include documentary evidence when required.

About notarization

This form is signed without a notary; the applicant affirms under penalties of perjury that the statements are true and correct.

How to submit this form

1
Download the Application
Download the Application for Correction of Death Certificate.
2
Complete and Sign the Form
Provide the requested certificate details, explain the error or omission, and sign and date the application.
3
Gather Supporting Evidence
Include documentary evidence if required for the requested correction; the instructions describe exceptions.
4
Return the Application
Send the form to the local Registrar of Vital Statistics or the Correction Unit address listed in the instructions.

Frequently asked questions

Do I need a notary for the Application for Correction of Death Certificate?: No. The form is signed without a notary, but the applicant affirms under penalties of perjury that the statements are true and correct.
Who can complete this correction application?: The instructions say the form should be completed and signed by the physician who signed the original death certificate or the person who furnished information for it.
What supporting evidence should I include?: Documentary evidence is required for most corrections, but not for certain additions, minor spelling changes, or a date-of-birth change of one year or less. The evidence must identify the certificate and verify the correction.
How do I submit the correction application?: Return it to the Registrar of Vital Statistics for your local area or mail it to the Correction Unit, Vital Records Section, P.O. Box 2602, Albany, NY 12220-2602. Include evidence when required.

Need something notarized?

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