Do I need a notary for the death record copy application?

No. The application is signed and dated without a notary, and it does not mention any notarized or sworn attachment.

What information does the application ask for?

It asks for information about the deceased, the applicant’s relationship to the deceased, the purpose of the request, and the applicant’s signature and address.

Palmyra, NY · Wayne County

No notary required

Application to Local Registrar for Copy of Death Record

This application lets a person request a death record copy or no-record certification from Palmyra’s local registrar.

What this form is

Use this application to request a copy of a death record or a no-record certification from Palmyra’s local registrar. It asks for details about the deceased, the applicant’s relationship and purpose, and the applicant’s signature and address. For deaths occurring as of January 11, 1988, it also asks how many copies are requested with or without the confidential cause of death.

Who needs it

A person requesting a death record copy or no-record certification from Palmyra’s local registrar should complete this application.

How to submit it

Complete the form and return it to Palmyra, NY 14522 with the $10.00 fee per copy or no-record certification. Do not send cash or stamps.

About notarization

This document is signed and dated without a notary; the form does not mention any notarized or sworn attachment.

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, then sign and date the form.
3
Gather The Fee
Enclose $10.00 per copy or no-record certification. Do not send cash or stamps.
4
Return The Application
Return the completed application and fee to Palmyra, NY 14522.

Frequently asked questions

Do I need a notary for the death record copy application?: No. The application is signed and dated without a notary, and it does not mention any notarized or sworn attachment.
How do I submit the death record copy application?: Complete the form and return it to Palmyra, NY 14522 with the $10.00 fee per copy or no-record certification. Do not send cash or stamps.
What information does the application ask for?: It asks for information about the deceased, the applicant’s relationship to the deceased, the purpose of the request, and the applicant’s signature and address.

Need something notarized?

This Application to Local Registrar for Copy of Death Record doesn’t need a notary — but if you have another Palmyra form that does, a commissioned online notary can help.