Date

Department of Vital Statistics
Address
City, State, Zip
Dear Registrar:

Would you please search for and provide a full transcript of the certificate of death for:

(Name of Person)
sex and race:
Date of Death:(approximate if unknown)
Born: (give approximate dates if unknow)
Name of Spouse:
Residence at time of death:

Please advise who received the ashes of the deceased if cremation occurred. My relationship to the above is (list as it is, daughter, son etc..)and my reason for this request is judicial need.

Enclosed is a certified check/money order in the amount required for a search and a copy of the record.

Sincerely,

Name (signature)
address
city, state, zip