Application for Copy of Death Certificate
Preston County, West Virginia
[Records available from 1869 to the present]
PLEASE NOTE: Print or type this form. Incomplete applications will not be accepted. All applicants
must be at least 18 years of age, with few exceptions.
Name at Death:
First Middle Last
Date of Death: Sex: Male; Female
Month/Day/Year
Place of Death:
City County State
Your relationship to the person whose death record is requested: Parent/Grandparent;
Brother/Sister; Child/Grandchild; Spouse; Legal Representative (i.e. attorney,
physician, funeral director, etc.); Other (describe)
By my signature, I certify that the above marked relationship is true:
Signature Print Name Date
Number of Copies Requested: at $5.00 per copy – Total amount enclosed
Payment options - cash/certified or cashier’s check/money order - payable to “Preston County Clerk”.
Personal checks will not be accepted.
Send copies to (print your name, address and daytime telephone below):
Name Daytime Telephone Number
Street Address City State Zip Code
Return Application to:
Linda Huggins, County Clerk
Preston County Courthouse Annex
106 W. Main Street, Suite 103, Kingwood, WV 26537
Telephone (304) 329-0070 ~ Fax (304) 329-0198
Clerk’s Initials
