Death Certificate Order Form

To order a death certificate:

Please use the application below to order a death certificate from the Department of Health for deaths that occurred January 1, 2010 or LATER. For deaths that occurred BEFORE January 1, 2010, please click on the following link to the be transferred to and place your certificate order with the Vermont State Archives and Records Administration (VSARA).

Vermont Department of Health logo

 

Application for a Certified Copy of a Death Certificate

For office use only

ID#
CPA#
REC#

Number of Copies:
Amount Enclosed $


Intended use of certificate

Date: _____________________________

Signature: _____________________________________________________________________

Send to: Vermont Department of Health, Vital Records, PO Box 70, Burlington, VT 05402-0070