Pennsylvania Department of Health - Vital Records · Pennsylvania state form
HD002191 Request to Amend a Death Record
Use form HD002191 to request changes to demographic information on a Pennsylvania death record. The informant or someone with an authorizing court order may submit it.
- What this form is
- Form HD002191 is used to request amendments to the demographic portion of a death record filed in Pennsylvania. The informant listed on the record or an individual with a court order authorizing the changes may apply. Provide supporting documentary evidence and identification as specified. After the record is amended, the requester will be notified and may apply for an updated death certificate.
- Who needs it
- The informant listed on the death record or an individual submitting a court order authorizing changes may use this form.
- Why it needs a notary
- You must sign in front of a notary unless you submit a certified copy of an authorizing court order. Notarization can be done online with a commissioned online notary.
- How to submit it
- Include the required documentary evidence and identification, then mail the form to the Pennsylvania Department of Health, Bureau of Health Statistics and Registries, ATTN: Death Registry, 555 Walnut St., 6th Floor, Harrisburg, PA 17101-1934.
Questions
Who can request an amendment to a death record?
The form may be used by the informant listed on the death record or by an individual who has obtained a court order authorizing the amendment.
Is a notary needed for form HD002191?
Yes. You must sign in front of a notary unless you submit a certified copy of a court order authorizing the changes. Online notarization with a commissioned online notary is available.
What documents must I include?
Provide documentary evidence supporting the requested change and a legible photocopy of valid government-issued photo identification. If you lack valid government photo ID, provide two current documents verifying your name and address.