"Application for a Certified Copy of Death Certificate or Verification" - Nevada

"Application for a Certified Copy of Death Certificate or Verification" - Nevada Download Pdf
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Application for a Certified Copy of Death Certificate or Verification is a legal document that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada.

Form Details:

  • Released on December 16, 2019;
  • The latest edition currently provided by the Nevada Department of Health and Human Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.

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DEATH
APPLICATION FOR A CERTIFIED
CERTIFICATE COPY OR VERIFICATION
FEE FOR A CERTIFIED DEATH CERTIFICATE COPY BY COUNTY
$25.00 per certificate (Carson, Clark, Douglas, Lyon, Mineral and Washoe Co.)
$22.00 per certificate (all other counties)
Number of
TYPE OF CERTIFICATE (Please check one type box below)
Copies
Certificate(s) to read as “Mother / Father”
Certificate(s) to read as “Parent / Parent”
VERIFICATION ONLY
Verifies the existence of a record with the State of Nevada and does not include a certified copy.
Search/Verification - $10.00 per search / verification
Make payment payable to: Office of Vital Records. Checks, money orders and credit cards are accepted. Please
include an “Authorization for Credit Card Use” form and the card holder’s identification if paying by credit card.
CASH FOR WALK-IN CUSTOMERS ONLY.
A COPY OF THE APPLICANT’S PHOTO IDENTIFICATION AND FULL PAYMENT IS REQUIRED FOR ALL REQUESTS.
PROOF OF RELATIONSHIP IS REQUIRED FOR CERTIFICATE REQUESTS.
Name of the Person on the Certificate:
First
Middle
Last
Date of Death
County of Death
Social Security Number
Parent’s First and Last Name
Parent’s First and Last Name
Last Name(s) Prior to First Marriage
Funeral Home / Mortuary in Charge of Arrangements
NRS 440.650 and NAC 440.070 requires the applicant to establish a direct relationship by blood or marriage, a legal relationship or a
need to facilitate a legal process to receive a certified copy of a record. Below, indicate your relationship or your legal need for this
certificate. Please provide proof such as a birth certificate or court order, unless the applicant is the informant, listed surviving
spouse or a parent listed on the certificate. The request will be rejected if sufficient proof is not provided. Visit our website listed
above for more information regarding proof required.
Name of the Person Requesting the Certificate:
Relationship and Reason for Request
Applicant’s Printed Name
Applicant’s Signature
Applicant’s Address
Applicant’s Phone Number
FOR OFFICE USE ONLY
Receipt number: ___________________________________
Date: ______________________
(Rev.12/16/2019)
Office of Vital Records and Statistics
4150 Technology Way, Suite 104 ● Carson City, Nevada 89706
775-684-4242 ● Fax 775-684-4156 ● dpbh.nv.gov/Vitalrecords
Page 1 of 1
DEATH
APPLICATION FOR A CERTIFIED
CERTIFICATE COPY OR VERIFICATION
FEE FOR A CERTIFIED DEATH CERTIFICATE COPY BY COUNTY
$25.00 per certificate (Carson, Clark, Douglas, Lyon, Mineral and Washoe Co.)
$22.00 per certificate (all other counties)
Number of
TYPE OF CERTIFICATE (Please check one type box below)
Copies
Certificate(s) to read as “Mother / Father”
Certificate(s) to read as “Parent / Parent”
VERIFICATION ONLY
Verifies the existence of a record with the State of Nevada and does not include a certified copy.
Search/Verification - $10.00 per search / verification
Make payment payable to: Office of Vital Records. Checks, money orders and credit cards are accepted. Please
include an “Authorization for Credit Card Use” form and the card holder’s identification if paying by credit card.
CASH FOR WALK-IN CUSTOMERS ONLY.
A COPY OF THE APPLICANT’S PHOTO IDENTIFICATION AND FULL PAYMENT IS REQUIRED FOR ALL REQUESTS.
PROOF OF RELATIONSHIP IS REQUIRED FOR CERTIFICATE REQUESTS.
Name of the Person on the Certificate:
First
Middle
Last
Date of Death
County of Death
Social Security Number
Parent’s First and Last Name
Parent’s First and Last Name
Last Name(s) Prior to First Marriage
Funeral Home / Mortuary in Charge of Arrangements
NRS 440.650 and NAC 440.070 requires the applicant to establish a direct relationship by blood or marriage, a legal relationship or a
need to facilitate a legal process to receive a certified copy of a record. Below, indicate your relationship or your legal need for this
certificate. Please provide proof such as a birth certificate or court order, unless the applicant is the informant, listed surviving
spouse or a parent listed on the certificate. The request will be rejected if sufficient proof is not provided. Visit our website listed
above for more information regarding proof required.
Name of the Person Requesting the Certificate:
Relationship and Reason for Request
Applicant’s Printed Name
Applicant’s Signature
Applicant’s Address
Applicant’s Phone Number
FOR OFFICE USE ONLY
Receipt number: ___________________________________
Date: ______________________
(Rev.12/16/2019)
Office of Vital Records and Statistics
4150 Technology Way, Suite 104 ● Carson City, Nevada 89706
775-684-4242 ● Fax 775-684-4156 ● dpbh.nv.gov/Vitalrecords
Page 1 of 1
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