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 by providing details about the deceased, their relationship, and where to send the record.
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 person's identifying details, date and place of death, the purpose of the request, and the applicant's relationship and contact information. The form also asks where the record should be sent and states a fee of $10.00 per copy or No Record Certification.
Who needs it
Anyone requesting a death record copy or No Record Certification can use this application to provide the required details and mailing address.
How to submit it
Complete the form and enclose the fee of $10.00 per copy or No Record Certification; do not send cash or stamps. Mail it to the New York State Department of Health, Vital Records Section, Empire State Plaza, Albany, New York 12237-0023.
About notarization
This document is signed and dated without a notary; the form lists no notarized or sworn attachment, 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 Form
Print or type the deceased person's details, request purpose, your relationship, contact information, and mailing address for the record.
- 3
Gather the Fee
Enclose the stated fee of $10.00 per copy or No Record Certification. Do not send cash or stamps.
- 4
Mail the Application
Mail the completed application and fee to the Vital Records Section at the address printed on the form.
Frequently asked questions
- Do I need a notary for the death record copy application?
- No. This application is signed and dated without a notary, and it lists no notarized or sworn attachment.
- How do I submit the death record copy application?
- Complete the form, enclose the stated fee, and mail it to the New York State Department of Health, Vital Records Section, Empire State Plaza, Albany, New York 12237-0023. Do not send cash or stamps.
- What information does the application ask for?
- It asks for details about the deceased, the purpose of the request, your relationship and capacity, your signature and address, and the address where the record should be sent.
- What fee does the form state?
- The form states a fee of $10.00 per copy or No Record Certification. It 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 Whitehall form that does, a commissioned online notary can help.