Application for Certified Copy of Death Record

* Required Field

After filling any form you must personally appear, with valid ID, within 10 working days, at the Clerk-Recorders Office, located in the Hall of Records, 155 Nelson Ave., Oroville.

These documents WILL NOT be sent to you; you MUST come to our office to pick them up. All fees will be calculated and must be paid at that time.

Effective July 1, 2003, California Health and Safety Code Section 103526 changed the way certified copies of birth certificates are issued. Certified Copies to establish the identity of a registrant can be issued only to authorized individuals, as indicated on the application. All others will be issued Certified Informational Copies that are not valid to establish identity.

Fees: $24.00 per copy (payable to the Butte County Clerk-Recorder).

Please indicate the type of certified copy you are requesting: *

I would like a Certified Copy. This copy will establish the identity of the registrant. (To receive a Certified Copy you must indicate your relationship to the registrant by selecting from the list below AND complete the attached Sworn Statement declaring that you are eligible to receive the Certified Copy.

-OR-

I would like a Certified Informational Copy. This document will be printed with a legend on the face of the document that states, "INFORMATIONAL, NOT A VALID DOCUMENT TO ESTABLISH IDENTITY." (A sworn statement does not need to be provided.)

NOTE: Both documents are certified copies of the original document on file with our office. With the exception of the legend, the documents contain the exact same information.

APPLICANT INFORMATION:
# Copies	Person Completing Application			Telephone (555-555-5555)	Address			City	State	ZIP Code
EMail Address (optional) Only used to notify you of the application status.
DEATH CERTIFICATE INFORMATION:			Sex * F M
Last Name on Certificate			First Name on Certificate		Middle Name on Certificate		City or Town of Death		County of Death If the certificate, or license was not issued in Butte County, then the Butte County Clerk-Recorder will not have the document. Please order from the Recorder or County Clerk of the county where it was issued.
Date of Birth (mm/dd/yyyy)		State of Birth		Date of Death (mm/dd/yyyy) (Or Period of Years to be Searched)		Social Security Number		Mother’s Maiden Name	Spouse of Decedent (Last, First, Middle)

Application for Certified Copy of a Death Record