Lyons, NY · Wayne County
Application for Copy of Death Record
This application lets a person request a copy of a death record or a no-record certification from a local registrar.
What this form is
Use this application to request a copy of a death record or a no-record certification. It asks for information about the deceased, including name, date of death, parents’ names, and place of death, as well as the applicant’s relationship to the deceased and the purpose of the request. The form states a fee of $10 per copy or certification and asks the applicant to enclose the fee.
Who needs it
Anyone requesting a copy of a death record or a no-record certification from a local registrar can use this application.
How to submit it
Complete the form and enclose the $10 fee per copy or no-record certification; do not send cash or stamps. Submit it to the city department named on the form; check the city website for current contact details.
About notarization
No notary is required for this application; the applicant signs and dates it, and the form lists no notarized attachment or sworn step.
How to submit this form
- 1
Download the Application
Download the death record copy application.
- 2
Complete the Form
Print or type the requested information about the deceased and applicant.
- 3
Enclose the Fee
Include $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 and check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the death record copy application?
- No. The application has a signature and date line but no notary block, and it lists no notarized attachment or sworn step.
- How do I submit the death record copy application?
- Complete the form and enclose $10 per copy or no-record certification. Do not send cash or stamps. Submit it to the city department named on the form; check the city website for current contact details.
- What information does the application ask for?
- 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.
Need something notarized?
This Application for Copy of Death Record doesn’t need a notary — but if you have another Lyons form that does, a commissioned online notary can help.