City Of Mcallen Mcallen Death Certificate Application printable pdf download

City of McAllen

McALLEN DEATH CERTIFICATE APPLICATION

VITAL STATISTICS

VOIDS_____________ Copy/ies # _____________

PO BOX 220

(956) 681-1195

McAllen Texas 78505

Date___________________

______________

Please complete all questions and sign application

: ___________________________________________________________

Name of Deceased

:_____________________________________________ Sex

Date of Death

{ } Male { } Female

Month / Day / Year

:_______________________________________________________________

Place of Death

(WE CAN ONLY ISSUE IF PERSON DIED IN McALLEN) Please indicate Hospital Name, Nursing Home, or Home

:___________________________________________________________

Full Name of Father

:_____________________________________________________

Full Maiden Name of Mother

What is YOUR relationship to the person whose certifícate you want: (check one)

Spouse

{ }

- must be listed on certificate as such (Current US Government issued picture ID* required)

Parent

{ }

– must be listed on certificate (Current US Government issued picture ID* required)

{ } Son/Daughter (Current US Government issued picture ID* and certified birth certificate (not a copy) required)

{ } Brother/Sister (Current US Government issued picture ID* and certified birth certificate (not a copy) required)

{ } Funeral Director (Must be affiliated with funeral home who handled the service)

{ } Informant (Current US Government issued picture ID* required)

Only those listed above are qualified applicants

The fee is $21.00 for the first copy and $4.00 for each additional copy after the first each time they are requested.

How many copies are you requesting?_______________________

Note: A searching fee of $21.00 will be charged if no record is found.

My purpose to obtain this record is: _____________________________________________________________________

Indicate what valid (CURRENT) photo identification you will present of yourself (REQUIRED):

( ) US Driver’s License* ( ) US Issued ID* ( ) US Passport ( ) Resident Alien ( ) Border Crosser

PLEASE FILL OUT THE FOLLOWING WITH YOUR INFORMATION:

*add’l documentation may be needed

Name:

____________________________________________________________________________________

Current Physical Address:

________________________________________________________________

City/State:

________________________________________________________________________________

Phone Number:

__________________________________________________________________________

Your Date of Birth: ___________________________________________________________

WARNING: The penalty for knowingly making a false statement on this form can be 2-10 years in prison and a fine of up to $10,000

(Health and Safety Code, Chapter 195, Sec. 195.003.)

Signature: ________________________________________________________Date:________________________

NOTE: If you are mailing in this application to us from outside the RGV, you will need to attach a copy of both sides of your identification

such as one of those indicated above that is not expired and other documents as required above, & a Money Order for our fee – we do not take

personal checks for payment on mail requests. For FED EX OR UPS ONLY please send to 221 S. 15th, McAllen TX 78501. For Regular,

Priority & Express Mail (U.S. Postal Service) send to P.O. Box 220 McAllen, Texas 78505. We mail requested document back to

applicant in an express manner ONLY through the US Postal Service with a prepaid & self-addressed envelope which must be provided

with request. No calling for pick-up will be done by our office to any shipping service, we only mail back by US Postal Service.

WE DO NOT ACCEPT REQUESTS FROM OTHER COUNTRIES NOR MAIL CERTIFICATES OUT OF THE UNITED STATES.

City Of Mcallen Mcallen Death Certificate Application

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