Information to locate death record:
MANDATORY FOR CERTIFIED RECORDS - Check the box below that describes your relationship to the subject of the record:
PENALTIES: Any person who willfully and knowingly provides false information for a certified vital record may be sentenced up to one year in jail or a
fine of up to $3000 or both (Minnesota Statutes, section 144.227 and section 609.02, subdivision 3 and 4.)
Person completing this application – the requester:
DATE OF DEATH
____ / ____ / _______
BIRTH DATE OR AGE AT DEATH
SPOUSE ON RECORD (IF ANY)
DATE OF BIRTH
_____ / _____ / _________
MAILING ADDRESS
United Parcel Service (UPS) will not deliver to PO boxes or APO addresses
Signature and Notary (If requesting a Certified Record by mail, fax, or email, application must be signed in front of a notary.)
I certify that the information provided on this application is accurate and complete to the best of my knowledge.
________________________________________________
Requester Signature
MINNESOTA DEATH CERTIFICATE APPLICATION
St. Louis County Recorder
PO Box 157 Duluth, MN 55801
Death certificates available to individuals who meet any of the legal requirements in items 1-14 below
1. I am the child of the subject
2. I am the parent of the subject
3. I am the sibling of the subject
4. I am the spouse on the record
5. I am the grandparent of the subject
6. I am the grandchild of the subject
7. I am the party responsible for filing the death record
8. I am a personal representative and the certified copy is required for the administration of the estate
(Documentation is required)
9. I am a successor of the subject as defined in Minnesota Statutes, section 524.1-201 and the certified copy is required for
the administration of the estate (Documentation is required)
10. I am a trustee of a trust and the certified copy is required for the proper administration of the trust
(Documentation is required)
11. I have documentation that the record is necessary for the determination or protection of a personal or property rights
(you must submit documentation showing this relationship)
12. I represent an adoption agency and the record is needed to complete a confidential post-adoption search
(you must include a copy of your employee ID)
13. I am an attorney and have attached proof of my licensure
14. I am presenting your office with a court order issued by a court of competent jurisdiction (must be a certified copy)
15. I represent a local, state or federal government agency and the record is necessary for the governmental agency
to perform its authorized duties (you must include a copy of your employee ID)
16. I am a representative authorized by a person listed in 1-15 above
(you must include a notarized statement from a person listed above)
Type : $13
.00
Certified Record WITH Cause of Death
$13
.00
Certified Record WITHOUT Cause of Death (1997-present)
$13
.00
Non-certified Record
___ Add’l Copies of Same Record at $6
.00
each
Phone: (218) 726-2559 | Fax: (218) 725-5052
Email: birthdeathmarriage@stlouiscountymn.gov
Signed or attested before me on _________ day of _______________________________, 20____.
__________________________________________________
Notary Public Signature My commission expires ______________________. Notary Seal*
*If seal is raised and application is to be returned by fax or email, please lightly rub impression with pencil.
FOR ADMINISTRATIVE USE ONLY ID VIEWED ___________________ INITIALS __________ CASH ________ CHECK NO. ___________________ DCN ___________________________________________________
The information requested on this application is required by Minnesota Statutes, section 144.225, subdivision 7 and
Minnesota Rules, part 4601.2600. If you do not complete all fields, the application may be returned.
