Form DCH-0569-DX-AUTH "Application for an Authenticated/Apostilled Copy - Michigan Death Record" - Michigan

What Is Form DCH-0569-DX-AUTH?

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

Form Details:

  • Released on July 1, 2019;
  • The latest edition provided by the Michigan Department of Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DCH-0569-DX-AUTH by clicking the link below or browse more documents and templates provided by the Michigan Department of Health and Human Services.

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Download Form DCH-0569-DX-AUTH "Application for an Authenticated/Apostilled Copy - Michigan Death Record" - Michigan

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APPLICATION FOR AN AUTHENTICATED/APOSTILLED COPY—MICHIGAN DEATH RECORD
Michigan Department of Health and Human Services
INFORMATION ABOUT AUTHENTICATED CERTIFICATES: Authenticated (exemplified or containing an apostille) records
are typically required by foreign governments for an adoption, work visas, marriage in a foreign country, or establishing
residency. You must specify which country requires the document. Applying the apostille at the Secretary of State’s
Office of the Great Seal takes an additional 2-3 weeks after processing is complete at Vital Records.
PART 1 - APPLICANT’S INFORMATION
Applicant’s Name:
Mailing Address:
City:
State:
Zip:
Daytime Phone w/area code:
Other Phone w/area code:
PART 2 - CERTIFICATION OF INFORMATION PROVIDED
By signing this application, I understand that I am agreeing to pay for a search of the State of Michigan Vital Records with the
information that I provided. This does not guarantee that a record will be found.
► Applicant’s Signature:
Date:
PART 3 - PURPOSE FOR REQUESTING THE RECORD
PART 4 - SPECIFY COUNTRY OF USE
PART 5 - DEATH INFORMATION NEEDED TO FIND THE RECORD
If the exact date of death is unknown, please indicate the year you want searched. If you need additional years searched,
please see Part 4 payment box for fee information. We can do a search without the “county” of death, but it will not be a
thorough search.
Date of Birth
Date of Death
Name of
Deceased
(at time of death)
First
Middle
Last
(mm/dd/yyyy)
(mm/dd/yyyy)
Other variations of same name or locations
Decedent’s
Gender
Place of
 Male
Death
 Female
City
County
State
Please provide any of the following additional information that would help us locate the death record
Decedent’s
Decedent’s Social Security Number
Place of Birth
__ __ __ __ __ __ __ __ __
State
Country
Decedent’s
Decedent’s
Parent/Mother’s
Parent/Father’s
Name
Name
First
Middle
Last
First
Middle
Last
PART 6 - FEES Includes one certified copy or no-find letter
Base Fee:
Includes One Year Search
$42.00
$ 42.00
Additional Copies (Each)
x $26.00
$
Additional Years Search , # yrs
x $12.00
(when exact year unknown)
$
Years you want searched:
Expedited “RUSH” Service (additional) $25.00
$
For Accounting Use Only
Payment to “State of Michigan”
TOTAL
$
Is your request complete?
APPLICATION FOR AN AUTHENTICATED/APOSTILLED COPY—MICHIGAN DEATH RECORD
Michigan Department of Health and Human Services
INFORMATION ABOUT AUTHENTICATED CERTIFICATES: Authenticated (exemplified or containing an apostille) records
are typically required by foreign governments for an adoption, work visas, marriage in a foreign country, or establishing
residency. You must specify which country requires the document. Applying the apostille at the Secretary of State’s
Office of the Great Seal takes an additional 2-3 weeks after processing is complete at Vital Records.
PART 1 - APPLICANT’S INFORMATION
Applicant’s Name:
Mailing Address:
City:
State:
Zip:
Daytime Phone w/area code:
Other Phone w/area code:
PART 2 - CERTIFICATION OF INFORMATION PROVIDED
By signing this application, I understand that I am agreeing to pay for a search of the State of Michigan Vital Records with the
information that I provided. This does not guarantee that a record will be found.
► Applicant’s Signature:
Date:
PART 3 - PURPOSE FOR REQUESTING THE RECORD
PART 4 - SPECIFY COUNTRY OF USE
PART 5 - DEATH INFORMATION NEEDED TO FIND THE RECORD
If the exact date of death is unknown, please indicate the year you want searched. If you need additional years searched,
please see Part 4 payment box for fee information. We can do a search without the “county” of death, but it will not be a
thorough search.
Date of Birth
Date of Death
Name of
Deceased
(at time of death)
First
Middle
Last
(mm/dd/yyyy)
(mm/dd/yyyy)
Other variations of same name or locations
Decedent’s
Gender
Place of
 Male
Death
 Female
City
County
State
Please provide any of the following additional information that would help us locate the death record
Decedent’s
Decedent’s Social Security Number
Place of Birth
__ __ __ __ __ __ __ __ __
State
Country
Decedent’s
Decedent’s
Parent/Mother’s
Parent/Father’s
Name
Name
First
Middle
Last
First
Middle
Last
PART 6 - FEES Includes one certified copy or no-find letter
Base Fee:
Includes One Year Search
$42.00
$ 42.00
Additional Copies (Each)
x $26.00
$
Additional Years Search , # yrs
x $12.00
(when exact year unknown)
$
Years you want searched:
Expedited “RUSH” Service (additional) $25.00
$
For Accounting Use Only
Payment to “State of Michigan”
TOTAL
$
Is your request complete?
REQUESTING A MICHIGAN DEATH RECORD
The Michigan Vital Records office has records of deaths that occurred in Michigan and were filed with the state since 1867.
Occasionally, some of the records were not filed with the state; more records are missing from the pre-1906 files.
Death records are not restricted documents in Michigan. Anyone can request that a search be conducted if the application is
completed and signed, and submitted with the required fee paid.
APPLYING IN PERSON
PROCESSING TIMES FOR MAIL REQUESTS
LOCATION:
REGULAR SEARCH: The processing time for a regular
South Grand Building, 1st Floor
request will be approximately 5 weeks, depending on the
333 S Grand Avenue
volume of requests received.
Lansing MI 48933 (corner of Grand & Kalamazoo)
EXPEDITED (RUSH) SEARCH: The processing time for a
LOBBY HOURS: 8:00 am - 5:00 pm M-F except for
“rush” request will be approximately 2 weeks, depending on the
recognized state holidays.
volume of requests received.
DIRECTIONS: Visit our website at:
APOSTILLES: Applying the apostille at the Secretary of
www.michigan.gov/vitalrecords
or call 517-335-8666.
State’s Office of the Great Seal for any request takes an
additional 2-3 weeks after processing in Vital Records is
SAME DAY SERVICE: Orders at our counter must be
completed. If you request just a certified copy from our office
placed by 3:00 pm in order to receive same-day service.
before 2:00 pm, you can go in person (five blocks) and have
Additional “rush” fee of $12.00 is required for same-day
the apostille applied same-day.
service and you must allow up to a 2 hour waiting period
for the order to be processed. Genealogy requests may
take longer.
ADDITIONAL INFORMATION: If you find that the processing
times listed do not meet your needs, please call our Eligibility
PAYMENT: A money order, credit card or cash can be
Unit at 517-335-8666 and speak with a customer service
used at our front counter. A personal check can also be
representative. They may be able to offer additional help to
used if NOT same-day service. Make checks and
meet your individual situation.
money orders payable to “State of Michigan”.
www.michigan.gov/vitalrecords
MAIL APPLICATION TO
517-335-8666
REGULAR MAIL TO:
RUSH MAIL TO:
The Michigan Department of Health and Human Services (MDHHS)
Vital Records Requests
Vital Records RUSH
does not discriminate against any individual or group because of race,
PO Box 30721
PO Box 30721
religion, age, national origin, color, height, weight, marital status,
genetic information, sex, sexual orientation, gender identity or
Lansing MI 48909
Lansing MI 48909
expression, political beliefs or disability.
DCH-0569-DX-AUTH (Rev. 7-19) By Authority of MCL 333.2882(1)(c), MCL 333.2883(2), and MCL 333.2891(1-4)
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