Rosendale, NY · Ulster County
Application to Local Registrar for Copy of Death Record
This application requests a copy of a death record from the local registrar and is completed by the person seeking the record.
What this form is
Use this application to request a copy of a death record or a no-record certification from the local registrar. It asks for information about the deceased, the applicant’s relationship and purpose, and where the record should be sent. For deaths occurring as of January 1, 1988, it also asks how many copies to provide with or without the confidential cause of death.
Who needs it
Anyone requesting a death record copy or no-record certification from the local registrar should complete this application.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details. Enclose $10 per copy or no-record certification; do not send cash or stamps.
About notarization
This application is signed and dated without a notary; the form does not identify any 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
Print or type the deceased’s information, your relationship and purpose, and your applicant and mailing details.
- 3
Gather the Fee
Enclose $10 per copy or no-record certification. Do not send cash or stamps.
- 4
Submit the Application
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the death record application?
- No. The application is signed and dated without a notary, and the form does not identify any notarized attachment or sworn step.
- How do I submit the death record application?
- Submit it to the city department named on the form and check the city website for current contact details. Enclose $10 per copy or no-record certification; do not send cash or stamps.
- What information does the application request?
- It asks for details about the deceased, the applicant’s relationship and purpose, the applicant’s signature and address, and the address where the record should be sent.
- What does the application cost?
- The form states a fee of $10 per copy or no-record certification and says not to send cash or stamps.
Need something notarized?
This Application to Local Registrar for Copy of Death Record doesn’t need a notary — but if you have another Rosendale form that does, a commissioned online notary can help.