by Attorney George Teitelbaum and his Probate, Estate, Will, Trust, and Elder Law practice located in Washington DC and Maryland
District of Columbia Death Certificate Request
For District of Columbia Occurrences Only
Death Application Instructions
The death transcript request form contains 13 questions. A separate copy of the request form
should be completed for each person whose death record is being requested. However, multiple
copies of a single death record may be requested on the same form.
Items 1-4: Information about the deceased.
Items 5: Information about the record being requested.
Note: Persons entitled to purchase a vital record birth or death certificate included:
* The registrant
* An immediate nuclear family member
* A legal guardian
* A legal representative
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 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.
Items 10-13: Information about the designated recipient of the certificate(s).
After you print and sign your request, mail or bring the form and a copy of your picture ID with
your payment to:
Vital Records Division
825 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.
Mail-In Form
1. Name of Deceased: _____________________________________
2. Social Security Number of Deceased: - -
3. Sex: Male Female
4. Date of Death: / / (mm/dd/yyyy)
5. Death Certificate No: (if known) ____ ____________
6a. Total number of copies of certificate requested: @ $18.00 each:
6b.(a) Number with cause of death included: _____________
(b) Number with cause of death omitted: ______________
6c.Total Amount Enclosed: $__________________
7. Relationship to Deceased: Mother Father Spouse
Other
8. Signature of Requester: __________________________________
9. Date: ____/_____/________
Make Check/Money Order Payable to: DC Treasurer
Mail Certificate(s) to:
10. Name:_____________________________________________
11. Address:____________________________________________
12.City/State/Zip Code ___________________________________
13. Day Phone: (required) _________________________________
*Copy of Requester's Photo ID is Required!
Instructions to be completed:
1. Print, sign, date form and a copy of requester's photo ID
2. Enclose check / money order payable to: DC Treasurer
3. Mail to: Government of the District of Columbia
Department of Health
Vital Records Division
825 North Capitol Street, NE, First Floor
Washington, DC 20002
Phone: (202) 671-5000
For those that need further legal
assistance, The Probate, Will and Trust Lawyer Resource Center provides an introduction into the District of Columbia and Maryland law practice
of Attorney George Teitelbaum, licensed
both in DC and MD. Check out George Teitelbaum's Legal Experience and Background, as well as office locations and other contact information.
We offer a wide variety of estate and elder law services for clients throughout the District of Columbia and Maryland. For more information, please contact our law office today. Attorney George Teitelbaum also assists clients located out of state that may have legal issues in the District of Columbia or in Maryland. To go to my main web site Click here.
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