Gouverneur, NY · St. Lawrence County
Application to Local Registrar for Copy of Death Record
This application is for people requesting a copy of a death record or a No Record Certification from the 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 information about the deceased, including name, date and place of death, family details, and the purpose of the request, along with the applicant’s relationship, contact information, signature, and requested copy options. The form lists a fee of $10.00 per copy or No Record Certification.
Who needs it
Anyone requesting a death record copy or No Record Certification should complete the application with the deceased’s details and their own contact information.
How to submit it
The form lists a $10.00 fee per copy or No Record Certification and says not to send cash or stamps. Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This application is signed and dated without a notary; the form lists no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Application
Download the Application to Local Registrar for Copy of Death Record.
- 2
Complete The Form
Enter the deceased’s details, the purpose of the request, your relationship and contact information, and the requested copy options.
- 3
Review The Fee Information
The form lists $10.00 per copy or No Record Certification and says not to send cash or stamps.
- 4
Submit To The Local Registrar
Submit it 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 death record copy application?
- No. The application calls for the applicant’s signature and date, with no notary block or notarized attachment listed.
- How do I submit the death record copy application?
- The form names the local registrar but does not give a submission address. Check the city website for current contact details; do not send cash or stamps.
- What information does the application ask for?
- It asks for details about the deceased, the applicant’s relationship and contact information, the purpose of the request, and the number and type of copies requested.
- What fee does the form list?
- The application lists $10.00 per copy or No Record Certification and says not to send cash or stamps.
Need something notarized?
This Application to Local Registrar for Copy of Death Record doesn’t need a notary — but if you have another Gouverneur form that does, a commissioned online notary can help.