Rev. 012921
$26.00 first certified copy (includes filing fees)
$9.50 each additional certified copy.
□ Check – payable to City of Sterling Heights
□ Cash – in person
□ Credit Card – in person
□ Payment Received ______________________
DEATH CERTIFICATE REQUEST FORM
101.060.040.610.000
:
CITY OF STERLING HEIGHTS
OFFICE OF THE CITY CLERK
40555 UTICA ROAD, PO BOX 8009
STERLING HEIGHTS, MI 48311-8009
586-446-2420 Fax: 586-276-4077
Email: cityclerk@sterling-heights.net
Or drop this form along with a check in the drop box located in
the circle drive at the City Hall Entrance off of Utica Road.
Date of Request: ______________________________
1.
Name of Requester: ______________________________________________________________
Address: _______________________________________________________________________
City, State, Zip Code _____________________________________________________________
Phone No: ____________________________ Email: __________________________________
2.
Name of Deceased: ______________________________________________________________
Date of Death: __________________________________________________________________
Number of Certified Copies Requested: ______________________________________________
3.
How would you like to receive the copies?
□
□
Signature of Requester: _____________________________________ Date: _____________________
