PAGE 1 OF 2 OFFICE OF VITAL RECORDS 0 2 /2024
Death Certificate Request
Use this form to request a Minnesota death certificate. If we can’t locate the record with the information you provide,
we’ll send you a certified Statement of No Record Found.
NOTE: County offices generally provide the fastest service. Certified records of deaths from 1997 to the present are
available from any Minnesota county. Records for 1908 to 1997 deaths are only available from the county of death or
Minnesota Department of Health. Pre-1908 records are only available from the county where the death occurred.
It’s illegal to give false information to obtain a vital record, and it may subject you to fines, jail time, or both.
(Minnesota
Statutes 144.227)
Information about the deceased person – used to find the death record
Minnesota Rules 4601.2600
First name (required)
Middle name (required)
Last name (required)
Date of death [
MM/DD/YYYY
]
(required)
Date of birth [MM/DD/YYYY]
City of death
County of death (required)
State
MN
First parent’s name
Second parent’s name
Spouse on record (if any)
REQUIRED – Requester information
Minnesota Rules 4601.2600
Requester name (please print)
Date of birth (MM/DD/YYYY)
Street address
(Express delivery won’t deliver to PO boxes or APO addresses)
Daytime phone (10-digit)
Apt/Unit #
City
State
Zip code
Email
REQUIRED – Mark the boxes that describe your relationship to the deceased person
Minnesota Statutes 144.225
1.
☐
A child of the subject
2.
☐
The parent of the subject
3.
☐
The sibling of the subject
4.
☐
The spouse on the record
5.
☐
The grandparent of the subject
6.
☐
The grandchild of the subject
7.
☐
Subject’s personal representative: the certified death certificate is required for the administration of the estate
8.
☐
Successor of the subject; the certified death certificate is required for the administration of the estate
9.
☐
Trustee of a trust; the certified death certificate is required for the proper administration of the trust
10.
☐
Determination or protection of a personal or property right (You must submit documentation showing this relationship)
11. ☐ Adoption agency — to complete post-adoption search (Employee ID required)
12.
☐
Attorney – I am the subject’s attorney or the attorney for a person listed in items
1-10 above. My Minnesota Attorney License Number is:
If you are a NON-Minnesota attorney,
attach a copy of your attorney license
13.
☐
I am presenting a valid, certified copy of a U.S. court order (not a subpoena) that orders release of the death certificate to me
14.
☐
Local/state/tribal/federal governmental agency (Employee ID required)
15.
☐
I have a signed statement from a person listed above; it specifies the decedent’s full name (first, middle, last) and date of
death, the signer’s relationship to the subject of the record, and authorizes me to obtain the certificate.
16.
☐
I represent the Department of Veterans Affairs (Best practice: wait until family has verified death record).
REQUIRED – Sign this form in front of a notary public if ordering by mail or fax
Minnesota Rules 4601.2600
I certify that the information provided on this application is accurate and complete to the best of my knowledge.
Signature of requester named above
Date (if applying in person)
Notary
Signed or attested before me on day of , 20
Notary stamp/seal
Printed name of notary public
Notary public signature
My commission expires
DEATH CERTIFICATE REQUEST
PAGE 2 OF 2 OFFICE OF VITAL RECORDS 0 2 /2024
Requester Name:
Fees and records request
Fee
Death certificate with cause of death information (first copy)
$13
Death certificate without cause of death information–records 1997 to present (first copy)
$13
Additional death certificates
# of extra copies
$6 each
Veterans Affairs (VA) death certificate (for VA purposes only)**
# of copies
$0
Processing
Fee
Standard — request processed in the order received
$0
Faster — request handled ahead of standard requests (doesn’t include express delivery)
$20
Shipping
Fee
Regular first-class mail
$0
Express delivery (Check here
☐
to require a signature.)
$21
The Office of Vital Records and the express delivery service are not responsible for deliveries that do not require a
signature. Express delivery services will not deliver to PO boxes or APO addresses.
For delivery outside the United States, you must supply a prepaid express delivery envelope with your application.
Total due
Fees are due with the application and are non-refundable.
Payment method
☐ Credit card
MasterCard/VISA/Discover
Cardholder name
Valid thru
(MM/YY)
Card number
3-digit
code
☐ Check
Check #
Make check or money order payable to Minnesota
Department of Health. DO NOT SEND CASH. Checks
returned for non-payment will result in a $30 charge to
you. You could also face civil penalties.
☐ Money order
Money order#
Send your application and payment to:
Incomplete requests
Minnesota Department of Health
Office of Vital Records
Mail: PO Box 64499, St. Paul, MN 55164-0499
Fax: 866-416-1357 (credit card payments only)
Courier/express delivery: 625 Robert St. N, St. Paul, MN
55155 (no vital-records counter service at this location)
The Office of Vital Records returns applications that are
incomplete, not signed in front of a notary public, or
not paid in full at the time of application. (Minnesota
Statutes 144.226; Minnesota Rules 4601.2600)
Unresolved requests will be closed 12 months after we
receive them. Once a request is closed, you must
submit a new request and pay the fee again to update
the record and/or receive the vital records.
If you have questions, contact the Office of Vital Records at health.vitalrecords@state.mn.us or 651-201-5970.
** You may order a free VA death certificate if you are:
The surviving spouse or next of kin of a veteran
A service officer of any veterans organization chartered by the Congress of the United States
A county veteran service officer
A representative of the Department of Veterans Affairs