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DEATH RECORD REQUEST

  1. To request a Certified Copy of a Death Record, please complete the form below.  The fee is $10.00 per copy.  Online payment can be made by opening the link below.  If you want to Pick-up your certificate we accept cash or check.

    Thank you.

  2. Name of Deceased:
  3. Name of Requestor:
  4. Office Use Only

  5. Leave This Blank:

  6. This field is not part of the form submission.