Death Certificate Order Form

McCOMB & WAGNER

Death Certificate Order Form

NOTICE: McComb & Wagner can order Certified Death Certificates from the Health Department within 12 months from the date of death. After 12 months a Certified Death Certificate must be ordered directly from Washington State Vital Statistics.

Many families need one or more official certified copies of the death certificate to take care of certain estate, probate, or other business following a death. Certified Death Certificates are ordered and obtained from the local health department. You can have our firm order and obtain official certified copies of the death certificate from the health department for you to pickup at our office or for mailing. You may also order and obtain them directly.

DEATH CERTIFICATES

Select Order & Obtain Death Certificate*:

Total Number of Certified Death Certificates you want to order*:

Total Number of Corrected Certified Death Certificates*:

Total Number of DC Photo Copies from Archive*:

Instructions for Death Certificates*:

Mail DCs to Name:

Mail DCs to Address:

DECEDENT INFORMATION

First Name*:

Middle Name:

Last Name*:

Date of Death*:

City or County of Death*:

To receive a death certificate, you must indicate your relationship to the decedent and attest that you are authorized to receive the certificate.

I declare under penalty of perjory under the laws of the State of Washington that the infomation I have provided is true and correct. Further, be advised that willfully providing a false statement to vital records for a certificate is a gross misdemeanor under Washington law, RCW 70.58A.590(2).

APPLICANT INFORMATION

Relationship to Decedent*:

First Name*:

Middle Name:

Last Name*:

Telephone*:

Address*:

Email*:

Applicant Attestation*:

Please wait

My Selections

Total Cost: $0.00

SERVICE AREA

_____________________

King - Pierce - Kitsap

Thurston - Mason

Lewis - Grays Harbor

Jefferson - Pacific

Death Certificate Order Form

Death Certificate Order Form

My Selections

Less Discounts