Rush Notary

Penn Yan, NY · Yates County

No notary required

Death Record Application

This application lets a requester seek a death record copy or No Record Certification from the New York State Department of Health Vital Records Section.

What this form is

This application is used to request a copy of a death record or a No Record Certification from the New York State Department of Health Vital Records Section. It asks for details about the deceased, the applicant’s relationship and purpose, and the number of copies requested with or without confidential cause of death. The listed fee is $10 per copy.

Who needs it

A person seeking a death record copy or No Record Certification who can provide the deceased’s details and explain their relationship and purpose.

How to submit it

The form says to apply to the Local Registrar. It lists a $10 fee per copy or No Record Certification and says not to send cash or stamps.

About notarization

This application is signed and dated without a notary; it identifies no attachment or related step that must be notarized or sworn.

How to submit this form

  1. 1

    Download The Application

    Download the Death Record Application.

  2. 2

    Complete The Form

    Enter the deceased’s details, your relationship and purpose, and the requested number of copies.

  3. 3

    Sign And Date

    Add your signature, date, and address as requested on the form.

  4. 4

    Apply To The Local Registrar

    Apply to the Local Registrar. The form lists a $10 fee per copy or No Record Certification and says not to send cash or stamps.

Frequently asked questions

Do I need a notary for the Death Record Application?
No. This application is signed and dated without a notary; the form identifies no attachment or related step that must be notarized or sworn.
How do I submit the Death Record Application?
The form says to apply to the Local Registrar. It lists a $10 fee per copy or No Record Certification and says not to send cash or stamps.
What information does the application request?
It requests information about the deceased, the applicant’s relationship and purpose, the applicant’s signature and address, and the number of copies requested.
How much does a death record copy cost?
The application lists a fee of $10 per copy or No Record Certification. It says not to send cash or stamps.

Need something notarized?

This Death Record Application doesn’t need a notary — but if you have another Penn Yan form that does, a commissioned online notary can help.