Office of Vital Records and Statistics
Attn: Customer Service
4150 Technology Way, Suite 104 ● Carson City, Nevada 89706
775-684-4242 ● dpbh.nv.gov/vitalrecords
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APPLICATION FOR A CERTIFIED COPY OF DEATH CERTIFICATE
DEATH CERTIFICATE FEES:
$25 EACH IF THE DEATH OCCURRED IN THE FOLLOWING COUNTIES: CARSON, CLARK, DOUGLAS, LYON, MINERAL OR WASHOE
$22 EACH IF THE DEATH OCCURRED IN ANY OTHER NEVADA COUNTY
Number of Copies
PARENTAL INFORMATION (Please check one type box below)
Parents’ information to be listed on the certificate as “Mother / Father”
Parents’ information to be listed on the certificate as “Parent / Parent”
Please Note: If a record is not found, a non-refundable $10.00 search fee will be applied.
MAKE PAYMENT PAYABLE TO: Office of Vital Records. Checks, money orders and credit cards are accepted. Please include the “Authorization
for Credit Card Use” form and the card holder’s identification if paying by credit card. Please DO NOT mail cash with your application.
A COPY OF THE APPLICANT’S PHOTO IDENTIFICATION AND FULL PAYMENT IS REQUIRED FOR ALL REQUESTS. PROOF OF
RELATIONSHIP IS REQUIRED FOR CERTIFICATE REQUESTS.
Name of the Person on the Certificate
Social Security Number (Last 4 Digits)
Mother/Parent #1 First and Last Name
Father/Parent #2 First and Last Name
Last Name(s) Prior to First Marriage
Funeral Home / Mortuary in Charge of Arrangements
NRS 440.650 and NAC 440.070 requires the applicant to establish a direct relationship by blood or marriage, a legal relationship or a need
to facilitate a legal process to receive a certified copy of a certificate. Below, indicate your relationship or your legal need for this
certificate. Please provide proof such as a birth certificate or court order. Unless the applicant is the informant, listed surviving spouse, or
a parent listed on the certificate, the request will be rejected if sufficient proof is not provided. Visit our website listed below for more
information regarding proof required.
Applicant’s Relationship To Person of Record
Applicant’s Mailing Address
Applicant’s Telephone Number
Applicant’s Email Address
Receipt/Applicant ID Number:
Rev. 04/07/21
