Stockholm, NY · St. Lawrence County
Affidavit to Request a Certified Copy of a Death Certificate for Dual Citizenship
This affidavit accompanies a request for a certified death certificate for a dual citizenship application and is completed by the person requesting 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
Use this New York State Department of Health affidavit when requesting a certified copy of a death record for a dual citizenship application. It asks for the deceased person’s details, the applicant’s relationship to the deceased, and the country where citizenship is being sought. The form also requests photocopies of citizenship requirements and relevant birth or marriage records to document the relationship.
Who needs it
A person requesting a certified New York death record for a dual citizenship application completes this affidavit and documents their relationship to the deceased.
Why it needs a notary
The form has a subscribed-and-sworn jurat; the applicant signs the affidavit and swears or affirms its statements before a notary public.
How to get this notarized
- 1
Download the Affidavit
Get the New York State Department of Health affidavit for a dual citizenship death certificate request.
- 2
Fill In the Details
Provide the applicant and deceased person’s information, your relationship, and the country where citizenship is sought.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary.
- 4
Sign on Video
Sign and swear or affirm the affidavit during the online notarization session.
- 5
Submit the Request
Send the notarized affidavit and required supporting photocopies according to the death certificate request instructions.
Preview the form
The blank PDF straight from Stockholm. 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 get this affidavit notarized online?
- Complete the form, then book a session with a commissioned online notary. New York authorizes its notaries to perform remote online notarizations under Executive Law §135-c, effective in 2023. Sign and swear or affirm during the video session.
- Do I need to bring supporting documents?
- The form instructs applicants to submit photocopies of the citizenship requirements and any birth or marriage records needed to document their relationship to the deceased.
- Who signs the affidavit?
- The applicant requesting the certified death record signs the affidavit and swears or affirms that its statements and accompanying documentation are true and correct to the best of their knowledge and belief.
- Where do I send the completed affidavit?
- The form is from the New York State Department of Health Vital Records Section. Check the death certificate request instructions for where to submit it; confirm with the city, town or village if unsure.
Other forms in Stockholm
Affidavit to Request a Certified Copy of a 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.