Death Record Request

This application is for a person requesting a copy of a death record or a no-record certification from the New York State Department of Health.

What this form is

Use this application to request a copy of a death record or a no-record certification. It asks for details about the deceased, the applicant’s relationship and capacity, the purpose of the request, and the number of copies requested. The form states a fee of $10.00 per copy or no-record certification and asks applicants to enclose the fee without sending cash or stamps.

Who needs it

A person requesting a death record copy or no-record certification completes this application and provides information about the deceased and their relationship to the person.

How to submit it

Complete the form and enclose the $10.00 fee per copy or no-record certification; do not send cash or stamps. It names the New York State Department of Health Vital Records Section but provides no mailing address.

About notarization

This document is signed without a notary; the applicant just signs and dates it.

How to submit this form

1
Download The Application
Download the Death Record Request application.
2
Complete The Form
Provide the requested information about the deceased, yourself, your relationship, and the purpose of the request.
3
Enclose The Fee
Enclose $10.00 per copy or no-record certification. Do not send cash or stamps.
4
Submit The Application
The form names the New York State Department of Health Vital Records Section but does not give a mailing address.

Frequently asked questions

What is the Death Record Request application for?: It is used to request a copy of a death record or a no-record certification from the New York State Department of Health.
What information does the application ask for?: It asks for details about the deceased, the applicant’s relationship and capacity, the purpose of the request, and the number of copies requested.
Do I need a notary for the Death Record Request?: No. This document is signed without a notary; the applicant just signs and dates it.
How do I submit the Death Record Request?: Complete the form and enclose the stated fee. The document names the New York State Department of Health Vital Records Section but does not provide a mailing address.

Need something notarized?

This Death Record Request doesn’t need a notary — but if you have another Madrid form that does, a commissioned online notary can help.