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Application for a Death Certificate

  • Please fill out the following form to request a death certificate. We will process the request as quickly as possible. Included with the certificate(s) will be an invoice for the total amount do.
    Please remit a check or money order made payable to "Monroe County Clerk" Please Note: If this is for genealogy there may be an extended wait time as we do not have staff to research old deaths.

  • Decedent's Information on Certficiate:

  • Sex: *

  • Date of Death: *

  • Requestor's Information:

  • Driver's License Scan: *
    (Acceptable Formats: .pdf, .png, .jpg, .jpeg, .gif, .tiff)

  • Relationship to Person on Certificate: *

  • Certificates are $5.00 a copy, how many copies do you need: *

* = Required