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Death Certificate Application

  1. The information requested on this application is required by Minnesota Statutes, section 144.225, subdivision 7 and Minnesota Rules, part 4601.2600. If you do not complete all fields, the application may be returned.

  2. You must check one.

  3. Application must be signed in front of a notary if applying by mail, fax, or email.

  4. I certify that the information provided on this application is accurate and complete to the best of my knowledge.

  5. Any person who willfully and knowingly provides false information for a certified vital record may be sentenced up to 1 year in jail or a fine of up to $3,000 or both (Minnesota Statutes, section 144.227 and section 609.02, subdivision 3 and 4).

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