DEATH CERTIFICATE REQUEST FORM

The fee is $30.00 for the first certified copy and $15.00 for each additional copy of the same certificate when ordered at the same time.

The deceased must have died in Onondaga County to obtain the certificate from this office. A person may get a death certificate if they are the spouse, child, or parent of the deceased.

Please fill out as many fields as you can, fields marked with a * are required:
Deceased Information
First Name: *
Middle Name:
Last Name: *
Date of Death: (MM/DD/YYYY) *
/ /
Place of Death (e.g. hospital or residence):
Village, Town, or City of Death  
 
County of Death:
 
NOTE: Deceased must have died in Onondaga County to obtain a certificate from this office.
Purpose for Which Record is Required: *
Cause of Death Required? *     Yes No
The cause of death will not appear on
certificate unless requested.
Relationship:
Describe your relationship to the deceased: *
In what capacity are you acting? (Example: Executor of Estate) *
If you are an Attorney, the name and relationship of your client to the deceased must be completed.
A copy of your Driver License and Bar Association Card or Unified Court System ID must be faxed.
Client:
Relationship:
Name and address of Applicant:
Name: *
(exactly as it appears on credit card)
Address: *
Address 2:
City: *
State:
Zip: *
Email: *
Confirm Email: *
Order Information:
Number of Copies Requested:*
 

 Expedited Shipping Options:

Please check here if you would like your order sent by Express Mail (2 to 3 day delivery). An additional $20.00 fee will be charged to your credit card.

Please check here if you would like your order sent by Next Business Day Delivery. An additional $25.00 fee will be charged to your credit card.

All documentation must be received by noon for same day expedited delivery. Otherwise, the expedited order will be shipped the next business day.

All other orders will be sent by regular U.S. Mail. Please allow 7-10 business days for processing your order.
Total Charge:
Credit Card Information:
Credit Card: *
Expiration Date*
/
Card Number: *
CID *
 
Card Holder Name:
Note: Card Holder Name must be the same as Applicant Name.
Address: (Billing Address) *
Address 2: (Billing Address)
City: *
State:
Zip: *
Daytime Phone: *
Shipping Information:
Name:
Note: Shipping Name must be the same as Applicant Name.
Address: *
Address 2:
City: *
State:
Zip: *
Printing Information:

If you decide to mail this form instead of submitting it on-line, you must sign and date below!
 
Signature: ___________________________________    Date: __________

Attention:
Please check to make sure that your order information is correct before you click the complete order button.

Make sure to click the Complete Order button only once. Wait for a response from the system. If you click the button more than once, you may be ordering more than once.