Pitcairn, NY · St. Lawrence County
Application for Copy of Death Record
This application lets a person request a copy of a death record or a no-record certification 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 details about the deceased, including name, date of death, and place of death, along with the applicant’s relationship, purpose, contact information, signature, and requested number of copies. The form lists a fee of $10.00 per copy.
Who needs it
Anyone requesting a copy of a death record or a no-record certification from the local registrar can use this application.
How to submit it
Submit the application to the local registrar. The form lists a fee of $10.00 per copy or no-record certification and says not to send cash or stamps.
About notarization
This application is signed and dated without a notary; the document lists no notarized attachment or sworn step.
How to submit this form
- 1
Download The Application
Download the death record copy application PDF.
- 2
Complete The Application
Enter the deceased’s details, your relationship and purpose, your contact information, and the number of copies requested.
- 3
Check The Fee Instructions
The form lists a fee of $10.00 per copy or no-record certification and says not to send cash or stamps.
- 4
Submit To The Local Registrar
Submit the completed application to the local registrar.
Frequently asked questions
- What does the death record application request?
- It requests information about the deceased and applicant, the purpose of the request, and the number of copies wanted, including whether to include confidential cause of death.
- Do I need a notary for the death record application?
- No. This application is signed and dated without a notary, and it lists no notarized attachment or sworn step.
- How do I submit the death record application?
- Submit it to the local registrar. The form lists a fee of $10.00 per copy or no-record certification and says not to send cash or stamps.
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.