Death Certificate Application - Montana Office Of Vital Statistics
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1MONTANA OFFICE OF VITAL STATISTICS
111 N SANDERS RM 6 / PO BOX 4210
HELENA, MONTANA 59604-4210
Phone: 406-444-2685
PLEASE READ THESE INSTRUCTIONS CAREFULLY
WHO CAN ORDER A DEATH CERTIFICATE?
Complete copies of a certified death certificate will be issued to anyone who submits a completed application, establishes their identity, and lists the reason for needing
the copy. If a death certificate lists the cause of death as "pending autopsy" or "pending investigation", a certified copy which has the cause of death information
removed will be issued.
IDENTIFICATION IS REQUIRED
The person signing the request must provide an enlarged legible photocopy of both sides of their valid driver’s license or other legal picture identification with a
signature or the requestor must have this application notarized.
Suggested Identification
Picture ID with a Signature
OR Two Forms of ID – One MUST have a Signature
OR
Driver’s License
Social Security Card
Credit/Debit/ATM Card
Notarized Montana Office of Vital Statistics
State ID Card
Work ID Card
School ID Card
Statement to Identify certified Birth or Death
Certificate Applicant form (you must
Passport
Car registration/Insurance
Library Card
provide the original letter, not a photocopy
Military ID Card
Doctor/Medical record
Insurance Record
or faxed copy)
Tribal
Fishing License
Pay Stub
Have an authorized family member that has
US Military DD 214
Traffic/ Pawn ticket
an ID order the certificate
Utility Bill with a current address
Court record
Voter Registration Card
Year Book
If a picture ID with a signature is not available, two other forms of identification are required; one MUST have a signature. Please include photocopies of both sides of
the ID when mailing your request
IMPORTANT: If the identification requirement is NOT met or if the application is incomplete, your request will be returned and significant delays in
processing your order may occur.
FEE (All fees must be U.S. funds)
CERTIFIED COPIES OF A DEATH CERTIFICATE cost $15.00 for the first copy, $8.00 for each additional copy of the same record. (non-refundable)
INFORMATIONAL COPIES OF A DEATH CERTIFICATE the cost is $13.00. (non-refundable)
CERTIFIED COPIES OF DOCUMENTS on file with the state (i.e., correction affidavits), the cost is $12.00. (non-refundable)
Please complete the following information.
Decedent’s Name
: _____________________________________________________________________________________________________________________
Date of Death (We need a date to begin searching if date is unknown): ___________________________Date of Birth: ________________________
Place of Death: _______________________________________________ Place of Birth: _______________________________________________
Parents Names: __________________________________________________________________________________________________________
Occupation: ________________________________________ Spouse’s Name: _____________________________________________________
Number of Copies __________________
Type of record needed? Certified ________________ Not Certified ______________
Reason record is needed ___________________________________________________________________________________________________
Mailing or Delivery Address:
Name: ___________________________________________________________________________________________________
Address: _________________________________________________________________________________________________
City, State, Zip: ______________________________________________ Daytime Telephone Number: __________________
Signature of Applicant: _____________________________________________Relationship: ______________________________
________________________________________Notary_(For use if needed)___________________________________________
personally appeared before me and whose identity I proved on the
Official Use Only
basis of satisfactory evidence to be the signer of the above instrument.
Date ______________________________
Subscribed and sworn to before me this________________________________ day of ____________ 20____
Rec# ______________________________
Amount ___________________________
Cert #______________________________
Signature: __________________________________________________
Ser #______________________________
Printed Name: ______________________________________________
SEAL
Notary Public in and for the State of _____________________________
Comment __________________________
Residing at _____________My commission expires: ________________
___________________________________
NOTICE: STATE LAW PROVIDES PENALTIES FOR PERSONS WHO WILLFULLY AND KNOWINGLY USES OR ATTEMPTS TO USE OR
FURNISH TO ANOTHER FOR USE, FOR ANY PURPOSE OF DECEPTION. (50-15-114(C), MCA)
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