Piercefield, NY · St. Lawrence County
Dual Citizenship Death Certificate Affidavit
This affidavit accompanies a request for a certified death certificate for a dual citizenship application and is completed by the person seeking the record.
- 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
The affidavit lets an applicant request a certified copy of a deceased person’s New York death record for a citizenship application. It asks for the applicant’s address, the deceased person’s identifying details, the place of death, the applicant’s relationship to the deceased, and the country where citizenship is sought. The form also directs applicants to provide copies of citizenship requirements and records documenting their relationship.
Who needs it
A person requesting a certified New York death record for a dual citizenship application completes this affidavit and provides the supporting records described on the form.
Why it needs a notary
The applicant signs before a notary, who completes the form’s “Subscribed and sworn to (affirmed) before me” block.
How to get this notarized
- 1
Download the Affidavit
Get the Dual Citizenship Affidavit to Request Certified Copy of Death Certificate.
- 2
Fill In the Details
Complete the applicant, deceased-person, relationship, place-of-death, and citizenship information, and gather the supporting records listed.
- 3
Book an Online Notary
Arrange a remote notarization and check that the Vital Records Section accepts the notarized format.
- 4
Sign on Video
Sign the affidavit in the notary’s presence and have the notary complete the sworn statement block.
- 5
Submit the Request
Send the affidavit and supporting documents according to the New York State Department of Health Vital Records Section’s instructions.
Preview the form
The blank PDF straight from Piercefield. 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 dual citizenship affidavit?
- Enter your details, the deceased person’s information, your relationship, and the country where you seek citizenship. Include the supporting citizenship and relationship records listed on the form.
- Do I need to sign this affidavit before a notary?
- Yes. The form has a “Subscribed and sworn to (affirmed) before me” block for the applicant to sign before a notary.
- Can I use a commissioned online notary?
- New York authorizes remote online notarization by a commissioned online notary under Executive Law §135-c. Confirm that the Vital Records Section will accept the notarized affidavit in your intended format.
- Where do I send the affidavit and supporting documents?
- The form is for a request handled by the New York State Department of Health Vital Records Section. Follow that office’s current submission instructions; confirm with the city, town or village if unsure.
Other forms in Piercefield
Dual Citizenship Death Certificate Affidavit in other St. Lawrence County cities
Each city publishes its own version of this form. Pick the city where you’re filing.