Form VR61 "Application for the Correction of a Certificate of Death" - New York City

What Is Form VR61?

This is a legal form that was released by the New York City Department of Health and Mental Hygiene - a government authority operating within New York City. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2002;
  • The latest edition provided by the New York City Department of Health and Mental Hygiene;
  • Easy to use and ready to print;
  • Available in Chinese;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form VR61 by clicking the link below or browse more documents and templates provided by the New York City Department of Health and Mental Hygiene.

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Download Form VR61 "Application for the Correction of a Certificate of Death" - New York City

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THE CITY OF NEW YORK
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
OFFICE OF VITAL RECORDS
CORRECTIONS UNIT
APPLICATION FOR THE CORRECTION OF A CERTIFICATE OF DEATH
(TO BE FILED ONLY BY THE NEXT OF KIN)
S
N
Y
}
TATE OF
EW
ORK
:
SS
C
OUNTY OF
(1)
being duly sworn
and state that
he/she is
years of age and resides at
(Street and Number)
(Borough)
(City)
(State)
(Zip Code)
that
he/she is the
of
who
(Relationship)
(Name of Deceased)
died at
Borough of
(Street and Number of Institution)
in the City of New York on
whose death certificate number
(Month/Day/Year–yyyy)
is on file in the Office of Vital Records of the Department of Health and Mental Hygiene.
(2) Applicant further says that the said certificate of death on file contains the following errors and/or omissions:
ITEM IN ERROR
AS IT APPEARS
AS IT SHOULD BE
(3) Documentary evidence, submitted in support of this application, includes:
ALL FOREIGN LANGUAGE DOCUMENTS MUST HAVE CERTIFIED ENGLISH TRANSLATION
(4) Applicant submits herewith a certified photostatic copy of the original record of death obtained from Department of
Health and Mental Hygiene and further states that this application covers all errors therein and supplies all information
missing from the original record.
Wherefore, the applicant requests the Commissioner of Health and Mental Hygiene of the City of New York to approve this
application and to make the appropriate changes, as aforesaid, on the original certificate of death.
Subscribed and sworn to before me this
day of
,
Signature
Year–yyyy
Notary Public or Commissioner of Deeds
ALTERED APPLICATIONS WILL NOT BE ACCEPTED.
When the application and affidavit is signed outside the United States or its dependencies they must be signed before the United States
Consul or his representative and must bear the seal of the Consul.
VR 61 (Rev. 8/02)
THE CITY OF NEW YORK
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
OFFICE OF VITAL RECORDS
CORRECTIONS UNIT
APPLICATION FOR THE CORRECTION OF A CERTIFICATE OF DEATH
(TO BE FILED ONLY BY THE NEXT OF KIN)
S
N
Y
}
TATE OF
EW
ORK
:
SS
C
OUNTY OF
(1)
being duly sworn
and state that
he/she is
years of age and resides at
(Street and Number)
(Borough)
(City)
(State)
(Zip Code)
that
he/she is the
of
who
(Relationship)
(Name of Deceased)
died at
Borough of
(Street and Number of Institution)
in the City of New York on
whose death certificate number
(Month/Day/Year–yyyy)
is on file in the Office of Vital Records of the Department of Health and Mental Hygiene.
(2) Applicant further says that the said certificate of death on file contains the following errors and/or omissions:
ITEM IN ERROR
AS IT APPEARS
AS IT SHOULD BE
(3) Documentary evidence, submitted in support of this application, includes:
ALL FOREIGN LANGUAGE DOCUMENTS MUST HAVE CERTIFIED ENGLISH TRANSLATION
(4) Applicant submits herewith a certified photostatic copy of the original record of death obtained from Department of
Health and Mental Hygiene and further states that this application covers all errors therein and supplies all information
missing from the original record.
Wherefore, the applicant requests the Commissioner of Health and Mental Hygiene of the City of New York to approve this
application and to make the appropriate changes, as aforesaid, on the original certificate of death.
Subscribed and sworn to before me this
day of
,
Signature
Year–yyyy
Notary Public or Commissioner of Deeds
ALTERED APPLICATIONS WILL NOT BE ACCEPTED.
When the application and affidavit is signed outside the United States or its dependencies they must be signed before the United States
Consul or his representative and must bear the seal of the Consul.
VR 61 (Rev. 8/02)
VR 61 (Rev. 8/02)
DO NOT WRITE ON THIS SIDE – TO BE COMPLETED BY THE DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Summary of documentary evidence submitted and salient facts contained herein:
No.
The City of New York
The City of New York
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Office of Vital Records
Office of Vital Records
Borough of
Date:
, Year
This is to certify that I have examined the
Application to correct record of DEATH of
original record which this application seeks to
correct.
I have also examined the documents
(Name)
submitted and I find sufficient evidence to
support this application. There are no omissions
(Date of Death)
or apparent errors in the original record that
have not been covered. This application is,
therefore, approved.*
(Certificate Number)
(Year–yyyy)
The evidence submitted with this case does
List of alterations requested:
not fully meet the requirements set forth in the
New York City Health Code; the application is
therefore for warded to the City Registrar for
consideration with recommendation that it be
*
(Approved)
(Denied)
(Date)
Deputy City Registrar
*Cross out paragraph which does not apply.
Approved:
(Date)
City Registrar
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