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*This is an ONLINE form and must be submitted using our Secure Online Payment Portal * DO NOT SEND US CREDIT CARD DETAILS BY MAIL - Mailing it in(with Bank Check or Money Order) will severely delay processing.

The cause of death will be visible

* NOTE: Total Due includes a 2.99% Credit Card Convenience Fee (billed separately by Elavon)

*This is an ONLINE form and must be submitted using our Secure Online Payment Portal *

Signature HereClick to Sign

09/17/2025Click to Sign

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Additional Signatures Required

Identification Requirements for submission of Death Record Application

Please upload the following attachments:

Identification Requirements

Application MUST be submitted with copies of Applicants Birth Certificate(attachment C)

AND either A or B

A. One of the following forms of valid photo-ID(Attachment-A)

VALID Driver license or State Issued Non-Driver Photo-ID Card
Military ID
VALID Passport

B. Two (2) of the following showing applicant’s name and address for 2 consecutive months: (Attachments-B1 & B2)

Utility bills
Telephone bills

C. Applicant’s birth certificate must be provided (Attachment-C) Note: NOT required for Spouse or Parent of decedent

There is a 250MB limit on each attachment

REQUIREMENT A: PHOTO-ID or REQUIREMENT B attachment 1 of 2 Click Here to Upload

REQUIREMENT B attachment 2 of 2 Click Here to Upload

BIRTH CERTIFICATE (Attachment C) Click Here to Upload

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