Item 6a: Please indicate the total number of certificates that you are requesting.
Item 6b/a: Please indicate the number of requested copies of certificates on which you wish to have the cause of death included.
Item 6b/b: Please indicate the number of requested copies of certificates on which you wish to have the cause of death omitted.
Item 6c: Please indicate the total amount of money that you are enclosing. This amount should equal the requested number of transcripts multiplied by $18.
If you send your request by mail, please enclose a check or money order
payable to the DC Treasurer. The DC Treasurer requires that all checks must have an address imprinted on them to be accepted for deposit. The cost of either type of transcript is $18.
Item 7: The requester's relationship to the deceased.
Item 8: Please sign your signature once the mail-in form has been completed.
Item 9: Please date the form.
Item 10:-13 Information about the designated recipient of the certificate(s).
After you print and sign your request,
click the clear button to erase the data you have entered, mail the form and a copy of your picture ID with your payment to:
Department of Health
Vital Records Division899 North Capitol Street, NE, First Floor
Washington, DC 20002
(202) 671-5000
If record is not located a "Certificate of Search" will be issued and the payment for the search is non-refundable. RESTRICTION on Access to Death Certificates: Pursuant to D.C. Official Code Sec. 7-220, the Vital Records Division may issue a certified copy of a death certificate ONLY to an applicant having a direct and tangible interest in the requested death certificate.
NOTE: This form should be used ONLY by a member of the registrant's immediate family, his/her guardian or legal representative.
