Pierrepont, NY · St. Lawrence County
Death Record Application
This application requests a copy of a death record and is completed by a person seeking the record 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, and parents’ names, as well as your relationship to the deceased, purpose for the record, and applicant contact details. For deaths occurring as of January 1, 1980, it also asks how many copies to request with or without the confidential cause of death.
Who needs it
Anyone requesting a death record copy or No Record Certification can complete the application with details about the deceased and the applicant.
How to submit it
Complete the application and enclose $10 per copy or No Record Certification; do not send cash or stamps. Submit it to the Local Registrar.
About notarization
This application is signed and dated without a notary; the form does not mention a notarized or sworn attachment.
How to submit this form
- 1
Download The Application
Download the Death Record Application PDF.
- 2
Complete The Application
Enter the requested information about the deceased, your relationship, the purpose, and your contact details.
- 3
Choose Copies
For deaths occurring as of January 1, 1980, indicate the number of copies requested with or without the confidential cause of death.
- 4
Enclose The Fee
Enclose $10 per copy or No Record Certification. Do not send cash or stamps.
- 5
Submit To The Registrar
Submit the completed application to the Local Registrar.
Frequently asked questions
- What does the Death Record Application request?
- It requests a copy of a death record or a No Record Certification and asks for details about the deceased, the applicant, and the purpose for the record.
- Do I need a notary for the Death Record Application?
- No. This application is signed and dated without a notary, and the form does not mention a notarized or sworn attachment.
- How do I submit the Death Record Application?
- Complete the application, enclose the stated fee of $10 per copy or No Record Certification, and submit it to the Local Registrar. Do not send cash or stamps.