FIRST Name of Deceased MIDDLE Name of Deceased LAST Name of Deceased
Place of Death - City and/or County
, OKLAHOMA
Check box if death was
stillbirth or fetal death
SECTION 2 (optional)
( )
-
Social Security Number of Deceased
Male Female
Spouse Name
Date of Birth (mm/dd/yyyy) Birth City and/or County State
Father’s Name Father’s Birthplace
Mother’s Name Mother’s Birthplace
Funeral Home Name & Address
STEP 2 - Complete the Order Information below:
A NON-REFUNDABLE record search fee
of $15 includes the issuance of one ceried copy if the record is found; additional copies are $15 each.
If no record is found, the fee will not be refunded. Should you recieve a request for more information, please respond promptly as all fees will expire
one year after the date paid.
STEP 1 - In order to accept this form, please read the following requirements:
• Section 1 must be completed in full. Section 2 is optional but may provide additional information to locate the record
• Enclose a copy of a current legal photo I.D. of the applicant (see back for a list of acceptable I.D.s)
• If mailing, enclose all the appropriate fees and include a self-addressed stamped envelope (see back for mailing address)
A NONREFUNDABLE /
NONTRANSFERABLE record search fee
of $15 includes the issuance of one
certied copy if the record is found;
additional copies are $15 each.
If no record is found, the fee will not be
refunded. Should you receive a request
for more information, please respond
promptly as all fees will expire one year
after the date paid.
STEP 2 - Complete the Order Information below:
QTY PRICE SUB-TOTAL ITEM DESCIPTION
Number of certied copies requested ($15 each and includes search fee)
Amendment Fee (required to amend non-medical certication items.
Includes 1 certied copy)
TOTAL AMOUNT ENCLOSED
DO NOT SEND CASH BY MAIL - Make checks payable to OSDH
$15
$35
STEP 3 - Final Check & Sign
Reviewed By: Date: / /
Fees Enclosed: $ Fees Due: $
ID Enclosed:
Clerk: Date: / /
Fees Paid: $ Check Cash MO CC
OFFICE USE ONLY
Mail
• Check to see if you have lled out all of the information elds and you have followed all instructions in Step 1.
• By signing below, you declare that all information provided on this request is true and correct:
Signature Date Signed
Family, specify________________ Legal Rep. of the Estate Funeral Director Court Order or other:
Your Name Daytime Telephone Number
Current Mailing Address (Required) APT# City / State / Zip
E-mail Address
No Email
Purpose for which the death certicate is needed: Estate Settlement Genealogy Other, specify:
Date of Death (mm/dd/yyyy)
This request is being made by:
(see eligibility instructions on back)
SECTION 1 (required)
OKLA
HOMA
DEATH CERTIFICATE
REQUEST FORM
DEATH CERTIFICATE REQUEST INSTRUCTION SHEET
AVAILABLE RECORDS
Oklahoma began ling death records in October of
1908; however, ling did not become mandatory until
1917. Prior to 1940 ling continued to be somewhat
sporadic, which may prove problematic for families
who may need proof of death for the settlement
of death claims or to obtain entitled benets.
ELIGIBILITY
By state law, with limited exception (see OPEN RECORDS
below), death records led with this oce are not
open for public inspection. The person requesting the
certicate must be acting in the decedent’s best interest:
• A surviving spouse, parent, child, grandparent,
sibling, ex-spouse or legal guardian;
• Legal representative of the estate of the
deceased as documented by an order from
a court of competent jurisdiction;
• An individual who can establish a familial
relationship with the deceased demonstrated
through certied copies of birth, death
and/or marriage certicates;
• Law enforcement or government ocials in the
capacity of ocial governmental business;
• Funeral director of record or agent thereto,
working in the capacity of their ocial business;
• Person with a court order from a court
of competent jurisdiction;
• A person who was a co-owner or a joint tenant
on real or personal property of the decedent; or
• A person listed in a will of the decedent,
provided the will is in probate;
By signing the request, you are indicating that
you are working in the best interest of the subject
of record. Documentation will be required to
demonstrate the applicant’s eligibility.
For a complete list of eligibility requirements, go to:
h
ttps://oklahoma.gov/health/birth-and-death-
certificates/death-certificate-eligibility
ACCEPTABLE PHOTO IDENTIFICATION (ID)
A photocopy of a valid government issued photo ID by either the applicant or an
individual attesting for the applicant is required.
Note: Send a photocopy. Do not send your original ID.
Photocopies must be legible and cannot be expired.
• U.S. Issued Driver’s license or Identication card
• U.S. Passport containing the bearer’s signature
• Foreign Issued Passport with Visa (I-94)
• Government issued Military photo ID
• Tribal Photo ID Card containing the bearer’s signature
• Ok Self-Defense Act (SDA) License or Concealed Carry permit
• Resident Alien Card (Form I-551)
• Employment Authorization Card (Form I-766)
• Employment Authorization Card (Form I-688A)
• Temporary Resident Card (Form I-688)
• Oklahoma Dept of Corrections Consolidated Record Card (CRC)
In cases when a primary ID is not available, records may be requested with two
secondary identications; however the record will only be mailed to the applicant
at the current address demonstrated on the identification.
For a complete list, go to https://oklahoma.gov/health/birth-and-death-
certificates/acceptable-identification
REQUIRED INFORMATION FOR A RECORD SEARCH
Certain information is required in order for to us to be able to process your
request in an expedient manner and to prevent unnecessary delays. Incorrect
information will delay the search and may result in your document not being
located. You can be assured that every attempt will be made to locate the record
you have requested. The minimum facts required include: 1) the full name of the
decedent at the time of death, 2) the date of death, and 3) the place of death.
OPEN RECORDS
Eective Nov 1, 2016, records of deaths
occurring at least 50 years ago are open record
and do not require proof of eligibility.
OPTIONAL INFORMATION TO ASSIST US IN
SEARCHING FOR THE RECORD
Any additional information you may have can assist us in our search such as
nicknames, a spouse’s name of a married female, whether the deceased was an
infant, or the name of the funeral director in charge of the decedent. You can be
assured that every attempt is made to locate the record you have requested.
RESPONSIBILITY FOR FILING DEATH
CERTIFICATES
QUESTIONS?
If you have any questions, visit our ocial website:
vr.health.ok.gov
Lobbies are currently closed for walk-ins.
Phone:
405.426.8880
Vital Records
Oklahoma State Department of Health
PO BOX 248964 • Oklahoma City, OK 73124-8964
MAIL YOUR APPLICATION TO:
It is the responsibility of the funeral director in charge of
the decedent at the time of death to properly obtain the
information needed from an immediate family member,
obtain the physician’s signature and cause of death
information, and then file the certificate in a timely
manner.
This publication was issued by the Oklahoma State Department of Health (OSDH), an
equal opportunity employer and provider. A digital file has been deposited with the
Publications Clearinghouse of the Oklahoma Department of Libraries in compliance with
section 3-114 of Title 65 of the Oklahoma Statutes and is available for download at
documents.ok.gov. | 18011VR
Email:
