Fillable Death Certificate Application for copy of (Town of Bar Harbor)

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Death Certificate Application for copy of (Town of Bar Harbor)

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The Death Certificate Application for copy of (Town of Bar Harbor) form is 2 pages long and contains:

  • 0 signatures
  • 35 check-boxes
  • 10 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Bar Harbor

BROWSE TOWN OF BAR HARBOR (ME) FORMS

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Application for copy of
Death Certificate
Full Name of Decedent:
Date of Death: How many copies?
Applicant → Name:
Address:
City, State, Zip:
Phone/Email (optional):
Indicate your relationship to the person whose record you have requested.
Informant Sibling Atty of Person on Record
Spouse Guardian Personal Representative
Reg. Domestic Partner Descendant (child / step child) Genealogist with State ID
Parent / Step Parent Aunt / Uncle #____________________
Grandparent Mother / Father-in law
By my signature below, I swear/affirm that the information above is true and correct.
Applicant Signature: Date:
$15 for 1
st
copy, $6 for each additional copy
(make checks payable to “Town of Bar Harbor”)
IMPORTANT INFORMATION ON REVERSE
Clerk’s Initials:
MAIL-IN CHECK LIST
SIGN AND DATE
COPY OF PROOF OF IDENTIFICATION
PAYMENT IN THE PROPER AMOUNT
revised March 03, 2014
You must provide proof of identity with this application.
Applicant must provide one (1) of these (please check which you have provided):
Driver’s License Passport
Government issued picture I.D.
OR two (2) of these:
Utility bill Social Security Card
Bank statement DD 214 (Military Discharge)
Vehicle registration Hospital; birth worksheet
Income tax return License/rental agreement
Personal check with correct address Pay Stub
Previously issued vital record W-2
Letter from government agency requesting record Voter Registration card
Department of Corrections I.D. card Disability award from SSA
Other:
NOTES
• We do not retain copies of proof provided or note any specific numbers.
• Domestic Partners must provide proof of registration of domestic partnership.
• Related applicants must provide proof of lineage.
• Custodians, guardians or representatives must provide documentation.
• Attorneys must provide a signed, notarized release from family.
• Genealogists must provide a state-issued I.D. card.
• Our Address is: Town of Bar Harbor
Clerk’s Office
93 Cottage St., Suite I
Bar Harbor, ME 04609-1400
• Our Telephone Number is: (207) 288-4098
• Make checks payable to: Town of Bar Harbor
revised March 03, 2014
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Death Certificate Application for copy of (Town of Bar Harbor)

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Completed 2 August 2020

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