The information requested on this application is required by Minnesota Statutes, section 144 - bigst 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part I: Death Record Information. Fill in the first name, middle name, last name, date of death, and date of birth or age. Ensure you also include the city and county of death along with the names of the mother and father.
3. Indicate your preference for a death certificate by checking one of the options regarding cause of death information.
4. Proceed to Part II: Requester Information. Enter your name, date of birth, mailing address (note that Federal Express does not deliver to P.O. boxes), city, state, daytime phone number, zip code, and email.
5. In Part III, specify your relationship to the subject of the record by checking the appropriate box. If applicable, provide any necessary documentation as indicated.
6. Complete Part IV by signing in front of a notary if submitting by mail or fax. Ensure all information is accurate.
7. Finally, fill out Part V for fee and payment information. Indicate how many certificates you are requesting and select your payment method before submitting your application.

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