General Instructions
- Use this application to submit
your request only for record of a death that occurred in Tompkins County. Send completed form plus fee by postal mail or in-person at the TCHD office.
- For record of a death that occurred in another county in NYS, contact the New
York State Health Department.
- Do not use this application for genealogy requests. Please
visit or genealogy page.
- Only the spouse, parent or child of the deceased may obtain
a death certificate copy.
- Other persons must submit a New York State court order or
documentation demonstrating that the death certificate copy
is required to establish a lawful right or claim (see
below).
- Other persons must submit a New York State court order or
documentation demonstrating that the death certificate copy
is required to establish a lawful right or claim (see
below).
- Download application (PDF, 67KB) and submit according
to "How to get..." (below).
- There is a $30 fee for each certified copy.
How to get a mail order copy
- Click here
to download a request form in PDF format (67KB).
- Adobe® Reader®
(version 5.0 or later) will allow you to enter your information directly into the form and
then print it out ready to sign and mail with check or money order.
- We recommend that you save the form to a location where you will be able to find it, before you start to enter
your information.
- When completing the form, please be aware that you will not be able to save the form with any information you
have entered.
- You must print the form after you complete it, then sign and mail with check or money order.
- You may also print the form and complete it by typing or printing, then sign and mail with check or money order.
- Send with the following:
- Indentification (Acceptable
forms of ID: Driver’s license, Non-driver’s license,
Passport, Naturalization Papers, Military ID, Employer’s
Photo ID, Two utility bills, showing applicant’s name
and address, Police report of lost or stolen ID)
- Applicable fee(s): $30
- Send to:
Tompkins County Health Department
Attn: Vital Records
55 Brown Road
Ithaca, NY 14850
What is a lawful right or claim?
If the applicant is not the spouse, parent or child of the decedent,
a lawful right or claim must be documented. An example of a lawful
right or claim would be a death record needed by the applicant
to claim a benefit. Documentation would consist of an official
letter from the agency (or attorney representing estate of the
deceased) verifying that to process the claim they require from
the applicant a copy of the requested death record.
*** $30 Fee Effective 1/1/2012 ***
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