DH 524, 04/2016, Florida Administrative Code Rule 64V-1.007 (Obsoletes Previous Editions)
INFORMATION AND INSTRUCTIONS FOR DEATH AMENDMENT APPLICATION
Statute/Rule references may be accessed through the website address at the bottom of this form
CAUSE OF DEATH INFORMATION: Pursuant to s. 382.025, Florida Statutes, except for those deaths occurring over 50 years ago, cause
of death information is confidential pursuant to Florida law and may only be issued as indicated in the section below. Cause of death
information on death records over 50 years old or a death certificate without cause of death is available to anyone of legal age (18)
completing an application and submitting the required fee.
ELIGIBILITY: Death records with the cause of death information may only be issued to the following individuals:
The decedent’s spouse or parent; child, grandchild or sibling, if of legal age;
To any person who provides a will, insurance policy or other document that demonstrates his or her interest in the estate of the
decedent;
To any person who provides documentation that he or she is acting on behalf of any of the before named persons; or
Court order.
REQUIREMENTS FOR OBTAINING CAUSE OF DEATH INFORMATION: Except for a legal representative such as an attorney or
funeral director, all requests for certification of a death certificate that includes the cause of death information, must include signature of the
applicant, state his or her qualifying eligibility AND provide photo identification. If you are a funeral director or attorney representing an eligible
person as listed above, include your professional license or bar number and the name and relationship of the person you are representing. If you
are not one of the persons listed above, you may only obtain cause of death information by submitting an affidavit signed by an eligible
person before a notarizing official or by court order. A form entitled Affidavit To Release Cause of Death Information, DH Form 1959, is
available upon request from this office, most local vital statistics offices within the county health department and our website.
If after reading the above information you are still uncertain regarding your eligibility for cause of death information, call our office (904) 359-
6900 extension 9000 for assistance.
NOTE: If needed for filing probate, be aware that Florida clerks of court will not accept a death record with cause of death shown.
MEDICAL AMENDMENT: Includes cause of death, manner of death, date of death, hour or time of death, place of death (other than street
address).
MISSING DATA: A search cannot be made without the decedent’s name and year. If any of the other items requested on the front of this
form are unavailable, some other identifying information (such as parents’ names, birthplace, etc) may be helpful if multiple records are found
for common names.
RESPONSE TIME: Response time for processing an amendment varies depending upon our workload at the time your request is
received. Generally, an amendment is completed and certification(s) issued within two to three weeks. RUSH processing is available to
those who need assurance of faster service. Orders received in an envelope marked RUSH and with the $10.00 RUSH fee will be given
priority over other pending work; no amended certificate can be issued until all required evidence, forms, applicable fees and appropriate
signatures have been received and meet the criteria as established in rules of the department.
FEES ARE NONREFUNDABLE: If no record is found, a “Not Found” statement will be issued. Fees are nonrefundable, except fees paid
for additional copies when no record is found. These are refunded on written request.
MAIL THIS APPLICATION WITH PAYMENT TO
DEPARTMENT OF HEALTH
OFFICE OF VITAL STATISTICS
P.O. BOX 210,
Jacksonville, FL 32231-0042
(Street Address: 1217 North Pearl Street, Jacksonville, Florida, 32202)
PLEASE VISIT OUR WEBSITE
www.FloridaVitalStatisticsOnline.com
