Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Death Certificate Application

  1. The information requested on this application is required by Minnesota Statutes, section 144.225, subdivision 7 and Minnesota Rules, part 4601.2600. If you do not complete all fields, the application may be returned.
  2. Death Record Information
  3. Please tick one of the following:
  4. Requestor Information
  5. What is your relationship to the subject (tangible interest)?
    You must check one.
  6. Signature & Notary
    Application must be signed in front of a notary if applying by mail, fax, or email.
  7. I certify that the information provided on this application is accurate and complete to the best of my knowledge.
  8. Penalties
    Any person who willfully and knowingly provides false information for a certified vital record may be sentenced up to 1 year in jail or a fine of up to $3,000 or both (Minnesota Statutes, section 144.227 and section 609.02, subdivision 3 and 4).
  9. Leave This Blank: