Death Certificate Online Application

Fill the form to start your death certificate request

Death information of the person on record

Please enter the information of the individual who needs the death certificate. If you are applying for someone else (i.e. your child), enter their death information here.

Do you know the exact date when the death occurred?

NoYes

Year of death

Date of Birth

Gender

MaleFemale

Has the decedent ever changed his/her name due to a marriage?

NoYes

Decedent first name

Decedent middle name

Decedent last name

State of death

County where event occured

City where event occured

Your name and contact information

First name

Middle name

Last name

Phone number

Email address

Confirm email address

Relationship to the person on record

What is your relationship with the person on the certificate?

Why are you applying for a death certificate?

Address where you would like the death certificate to be delivered

Street

Apt, suite, floor, etc.

City

State

Zip Code

Agreement and Privacy Policy

By checking this box, I agree to submit the information provided to this website, and I authorize Vitals USA to use my information to fill all necessary documents in order to prepare my application materials. I understand that vitals-usa.com is a private document preparation service and that I am hiring them to prepare my death certificate application materials. I understand there is a service fee charged by vitals-usa.com and I will pay the health department required fee directly by check or money order. I understand I may have to provide additional documents or notarize documents to the health department in order to prove my identity. By submitting the form above, I agree to these terms and the terms of this website.