Walworth, NY · Wayne County
Application to Local Registrar for Copy of Death Record
This application requests a copy of a death record from the Local Registrar and asks for details about the deceased and the applicant.
What this form is
Use this application to request a copy of a death record or a No Record Certification from the Local Registrar. It asks for the deceased person’s identifying details, the applicant’s relationship to the deceased, the purpose of the request, and the number of copies requested. The form states a fee of $10 per copy.
Who needs it
Anyone requesting a death record copy or No Record Certification from the 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.
About notarization
This application is signed without a notary; it lists no notarized or sworn attachment, so the applicant simply signs the form.
How to submit this form
- 1
Download the Application
Download the fillable application for a copy of a death record.
- 2
Complete the Form
Provide the requested details about the deceased, your relationship, the purpose, and the number of copies.
- 3
Enclose the Fee
Enclose the $10 fee per copy or No Record Certification. Do not send cash or stamps.
- 4
Submit to the Local Registrar
Complete the form and enclose the fee for the Local Registrar.
Frequently asked questions
- What does this application request?
- It requests a copy of a death record or a No Record Certification from the Local Registrar.
- What information does the application ask for?
- It asks for identifying information about the deceased, the applicant’s relationship and purpose, and the number of copies requested.
- Do I need a notary for the death record copy application?
- No. This application is signed without a notary, and it lists no notarized or sworn attachment.
- 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.
Need something notarized?
This Application to Local Registrar for Copy of Death Record doesn’t need a notary — but if you have another Walworth form that does, a commissioned online notary can help.