EmailMe Form - Application for Ohio Certified Death Record

Application for Ohio Certified Death Record

STEP 1: COMPLETE THIS ONLINE APPLICATION FORM
Only Ohio death records can be processed.

STEP 2: SUBMIT PAYMENT
Payment is required before processing your order.
Pay online through (Point and Pay).
Card fees apply both online and in person.
No refunds will be issued.

STEP 3: DELIVERY METHOD
You’ll choose Pickup or Mail in this application.
Pickup: Certificates can be picked up at 1550 Sheridan Dr., Suite 100, Lancaster, OH.
Mail: Certificates will be mailed to the address you provide on the application.
You’ll receive an email notification once your order is ready for pickup or has been shipped.

Questions? Call 740-652-2800, OPTION 2

DID THE DEATH OCCUR IN THE STATE OF OHIO? *
Yes
No, We are only able to process State of Ohio death records.
Please contact the vital records office in the state where the death occurred for assistance.
Date the death occurred: *
APPLICANT INFORMATION
Applicant Name: *
(the person requesting the record)
Street Address: *
(for death certificate to be mailed, if applicable)
City: *
State: *
Zip: *
Phone *
Email *
RECORD INFORMATION
(the person on the requested death record)
Enter Name of Deceased:
(name given at birth)
Enter Name at Date of Death *
(if different than name given at birth)
NUMBER OF COPIES *
PREFERRED DELIVERY METHOD *
Does the Social Security number need to appear on the Death Certificate?
No, Please submit the application and payment to initiate processing.
Did the death occur over five years ago?
Yes, Please submit the application and payment to initiate processing.
If death was within 5 years:
(please check which option applies to your situation)
Deceased's Current Spouse: Submit Proof of Identification and Proof of Marriage (marriage license)
Lineal Descendent (child, grandchild, etc.): Proof of Identification and Copy of Birth Certificate
Deceased's Executor, Attorney/Legal Agent or representative of an investigating government agency/veteran's service officer/accredited member of media: Proof of Identification, Paperwork confirming relationship
Funeral Director responsible for disposition of the body and acting on behalf of the deceased.
If you have any questions, please call 740-652-2800 option #2 or email the required support to vitalstats@fairfieldcountyohio.gov.

APPLICANT INFORMATION

RECORD INFORMATION

No, Please submit the application and payment to initiate processing.

Yes, Please submit the application and payment to initiate processing.