Salem, NY · Washington County
Application to Local Registrar for Copy of Death Record
This application lets a person request a copy of a death record from the local registrar by providing details about the deceased and the applicant.
What this form is
Use this application to request a copy of a death record from the local registrar. It asks for the deceased’s name, date and place of death, identifying details, the applicant’s relationship and purpose, and the number of copies requested. The form lists a fee of $10 per copy or No Record Certification and says not to send cash or stamps.
Who needs it
A person seeking a copy of a death record can use this application to provide information about the deceased and their request.
How to submit it
Send the application to the local registrar. The form lists a fee of $10 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; it lists no notarized attachment or sworn step, so the applicant just signs and dates it.
How to submit this form
- 1
Download The Application
Download the death record copy application.
- 2
Complete The Application
Enter the requested information about the deceased and applicant, state the purpose, and indicate the number of copies requested.
- 3
Sign And Date
Sign and date the application; the form does not list a notarized attachment or sworn step.
- 4
Submit To The Local Registrar
Send the application to the local registrar. The form lists a $10 fee per copy or No Record Certification and says not to send cash or stamps.
Frequently asked questions
- 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?
- Send the completed application to the local registrar. The form lists a fee of $10 per copy or No Record Certification and says not to send cash or stamps.
- What information does the application ask for?
- It asks for details about the deceased, including name, date and place of death, and identifying information, along with the applicant’s relationship, purpose, signature, address, and requested copies.
Need something notarized?
This Application to Local Registrar for Copy of Death Record doesn’t need a notary — but if you have another Salem form that does, a commissioned online notary can help.