Whitehall, NY · Washington County
Application to Local Registrar for Copy of Death Record
This application lets a person request a copy of a death record or a no-record certification by providing details about the deceased and the applicant.
At a glance
- Issued by
- City of Whitehall · Whitehall, Washington County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- whitehallny.org
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this application to request a copy of a death record or a no-record certification. It asks for the deceased’s identifying details, date and place of death, the applicant’s relationship and capacity, the purpose of the request, and where the record should be sent. The form instructs applicants to enclose the fee and not to send cash or stamps.
Who needs it
A person requesting a copy of a death record or a no-record certification completes the application with information about the deceased and the applicant.
How to submit it
Complete the form and enclose the fee of $10 per copy or no-record certification; do not send cash or stamps. The form lists NYS Department of Health Vital Records Section, Empire State Plaza, Albany, NY 12237-0023.
About notarization
This application is signed and dated without a notary; the signer just provides their signature and date.
How to submit this form
- 1
Download the Application
Download the Application to Local Registrar for Copy of Death Record.
- 2
Complete the Form
Print or type the deceased’s details, applicant information, purpose of the request, and mailing address for the record.
- 3
Enclose the Fee
Enclose $10 per copy or no-record certification. Do not send cash or stamps.
- 4
Send the Application
The form lists NYS Department of Health Vital Records Section, Empire State Plaza, Albany, NY 12237-0023.
Frequently asked questions
- Do I need a notary for the death record copy application?
- No. This application is signed and dated without a notary; the signer just provides their signature and date.
- How do I submit the death record copy application?
- Complete the form and enclose the $10 fee per copy or no-record certification. Do not send cash or stamps. The form lists the NYS Department of Health Vital Records Section address in Albany.
- What information does the application ask for?
- It asks for details about the deceased, the applicant’s relationship and capacity, the purpose of the request, and the name and address where the record should be sent.