What information does the death record copy 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 with or without the confidential cause of death.

Do I need a notary for the death record copy application?

No. The applicant signs and dates this application; it does not state that a notary, notarized attachment, or sworn step is required.

How do I submit the death record copy application?

The form is addressed to a local registrar or the New York State Department of Health Vital Records Section. It does not give submission contact details; check the city website for current information.

Pitcairn, NY · St. Lawrence County

No notary required

Application for Copy of Death Record

This application is for a person requesting a copy of a deceased person’s death record from a local registrar or the New York State Department of Health.

What this form is

Use this application to request copies of a death record. The form asks for information about the deceased, including their name, date and place of death, and parents’ names, along with the applicant’s relationship to the deceased and reason for the request. It also asks how many copies are requested with and without the confidential cause of death.

Who needs it

A person requesting a copy of a death record who can provide the deceased’s details, their relationship to the deceased, and the purpose of the request.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details.

About notarization

This application is signed without a notary; the applicant signs and dates it, with no notarized attachment or sworn step stated.

How to submit this form

1
Download The Application
Download the application for a copy of a death record.
2
Complete The Form
Fill in the deceased’s details, your relationship and capacity, the purpose of the request, and the number of copies requested.
3
Review The Request
Check the completed form for the deceased’s information and your applicant details; no attachments are specified on the form.
4
Submit The Application
The form names a local registrar or the New York State Department of Health Vital Records Section; check the city website for current contact details.

Frequently asked questions

What information does the death record copy 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 with or without the confidential cause of death.
Do I need a notary for the death record copy application?: No. The applicant signs and dates this application; it does not state that a notary, notarized attachment, or sworn step is required.
How do I submit the death record copy application?: The form is addressed to a local registrar or the New York State Department of Health Vital Records Section. It does not give submission contact details; check the city website for current information.

Need something notarized?

This Application for Copy of Death Record doesn’t need a notary — but if you have another Pitcairn form that does, a commissioned online notary can help.