Madrid, NY · St. Lawrence County
Affidavit to Request Certified Copy of Death Certificate for Dual Citizenship
This affidavit supports a request to the New York State Department of Health for a certified death certificate needed for a dual citizenship application.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
Use this affidavit when requesting a certified copy of a New York death record for a dual citizenship application. It asks for the applicant’s details, the deceased person’s information, the believed place of death, the citizenship purpose, and the applicant’s relationship to the deceased; the form also calls for supporting citizenship requirements and records that document the relationship.
Who needs it
A person requesting a New York death certificate for dual citizenship who must swear to their information and document their relationship to the deceased needs this affidavit.
How to get this notarized
- 1
Download the Affidavit
Get the affidavit and review its fields and supporting-document instructions.
- 2
Fill In the Details
Enter the applicant and deceased person’s information, citizenship purpose, and relationship details.
- 3
Book an Online Notary
Arrange a session with a commissioned online notary before signing.
- 4
- 5
Submit the Request
Send the notarized affidavit and required supporting documents as directed by the New York State Department of Health.
Preview the form
The blank PDF straight from Madrid. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete this death certificate affidavit?
- Fill in the applicant and deceased person’s details, the believed place of death, citizenship purpose, and relationship information. Attach the supporting documents listed on the form, then sign before a notary.
- Do I need to sign this affidavit in front of a notary?
- Yes. The form includes a “Subscribed and sworn to (affirmed) before me” jurat, so sign before the notary and leave the notary section for them to complete.
- Can I sign this form with an online notary?
- New York authorizes remote online notarization by its notaries under Executive Law §135-c, in effect since 2023. Book with a commissioned online notary and follow their instructions for signing on video.
- Where do I submit the affidavit and supporting documents?
- The form is from the New York State Department of Health Vital Records Section and requests supporting citizenship and relationship records. Confirm submission instructions with the department; confirm with the city, town or village if unsure.
Affidavit to Request Certified Copy of Death Certificate for Dual Citizenship in other St. Lawrence County cities
Each city publishes its own version of this form. Pick the city where you’re filing.