Form V03m - Application For A Death Certificate Or Letter Of No Record - 2015
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2COUNTY OF SAN DIEGO
FOR OFFICIAL USE ONLY
ERNEST J. DRONENBURG, JR.
ASSESSOR/RECORDER/COUNTY CLERK
BY MAIL
APPLICATION FOR A DEATH CERTIFICATE,
OR LETTER OF NO RECORD
$21.00
– PER COPY
FEES NON-REFUNDABLE
Per California State Law, Health and Safety Code, Section 103526(c), permits only
FOR OFFICIAL USE ONLY
authorized persons as defined below to request certified copies of Death Records.
Type of identification provided, if processed in person:
Those who are not authorized by Law to receive a certified copy will receive a
Driver’s License
Military ID
certified informational copy marked “INFORMATIONAL, NOT A VALID DOCUMENT
Passport
Other ___________
TO ESTABLISH IDENTITY.”
If we cannot identify the record based on the information you provided, State Law requires that we retain the fee and issue a “Letter of No Record”.
Please wait 6 weeks from the date of the event before submitting your request. You will be asked to present a valid photo ID for all in-person requests.
I would like a Certified Copy of the record identified on the application
I would like a Certified Informational Copy of the record identified
form. (In order to receive a Certified Copy, you must indicate your
on the application form. (You are not required to select from the
relationship to the person named on the application form by selecting
list below or complete the statement of identity in order to receive
from the list below.)
an Informational Copy.)
I am:
The parent or legal guardian of the decedent (person named on certificate).
A party entitled to receive the record as a result of a court order, or an attorney or a licensed adoption agency seeking the birth
record in order to comply with the requirement of Section 3140 or 7603 of the Family Code.
A member of a law enforcement agency or a representative of another governmental agency, as provided by law, who is conducting
official business.
A child, grandparent, grandchild, sibling, spouse, or domestic partner of the registrant.
An attorney representing the registrant or the registrant’s estate, or any person or agency empowered by statute or appointed by a
court to act on behalf of the registrant or the registrant’s estate.
Any funeral director who orders certified copies of a death certificate on behalf of any individual specified in paragraphs (1) to (5),
inclusive, of subdivision (a) of Section 7100.
DEATH INFORMATION ON CERTIFICATE
(PLEASE PRINT OR TYPE) - $21.00 for each certified copy
First Name
Middle Name
Last Name
Date of Death
County of Death
No. of Copies
DEATH INFORMATION ON CERTIFICATE
(PLEASE PRINT OR TYPE) - $21.00 for each certified copy
First Name
Middle Name
Last Name
Date of Death
County of Death
No. of Copies
DEATH INFORMATION ON CERTIFICATE
(PLEASE PRINT OR TYPE) - $21.00 for each certified copy
First Name
Middle Name
Last Name
Date of Death
County of Death
No. of Copies
Note: The Statement of Identity must accompany this request in our office before a certificate can be issued.
Requestor’s Name _______________________________________________________________________
PLEASE PRINT
V03M (06/22/17)
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