A Hospital or Healthcare Institution
  • An application or a letter on the letterhead of the hospital or healthcare institution shall be submitted that includes:
    • The name and address of the hospital or healthcare institution.
    • The name of and contact information for the hospital’s or healthcare institution’s designee for the request (telephone number or e-mail address).
    • Name of the deceased individual.
    • Date of birth of the deceased individual.
    • Date of death of the deceased individual.
    • If known, the:
      • Sex of the deceased individual
        • The state file number listed on the certificate of death registration.
        • Town/city of the deceased individual’s death.
        • Place of the deceased individual’s death
        • Funeral establishment or person responsible for the final disposition of the deceased individual’s human remains.
        • The deceased individual’s social security number.
    • A description of the claim against the deceased individual’s estate.
    • The reason the hospital or other health care institution is requesting a certified copy of the deceased individual’s certificate of death registration.
    • The designee/applicant provides a valid government issued identification or notarized signature on the application or letter.
  • A copy of documentation demonstrating that the hospital or other health care institution has a claim against the deceased individual’s estate.
  • The designee/applicant submits the appropriate fee(s).

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1. Funeral Director or Funeral Director’s Designee
2. Spouse
3. Parents
4. Grandparent
5. Adult Child
6. Grandchild
7. Brother or Sister
8. A Person Designated in a Power of Attorney
9. A Person Responsible for Final Disposition (Other than a Funeral Director)
10. A Person Named as the Executor or Beneficiary of the Deceased Individual's Estate
11. A Beneficiary of the Deceased Individual's Life Insurance Policy
12. A Person Named in a Court Order
13. A Person Authorized by an Eligible Person
14. An Insurance Company/Financial Institution
15. A Hospital or Healthcare Institution
16. A Person with a Court Order Having a Claim Against the Deceased Individual's Estate
17. An Attorney Representing a Person Eligible to Receive a Certified Copy
18. Consulate of a Foreign Government Request
19. Government Agency Request
20. Noncertified Copy: Genealogical Research
21. Noncertified Copy: Government Agency Request