T O W N O F W I L M I N G T O N
TOWN HALL
121 GLEN ROAD
WILMINGTON, MA 01887
OFFICE OF THE TOWN CLERK
PHONE (978) 658-2030
Christine R. Touma-Conway, Esq.
TOWN CLERK FAX (978) 657-7564
MAIL-IN REQUEST FOR DEATH RECORD
Certified copies of death records are available from the community where the death occurred, where the deceased
resided (if in Massachusetts), and at the Massachusetts Registry of Vital Records and Statistics.
If you are certain that the death record is on file in this office, you may order a copy by printing this form, completing as
much detail as is available and mailing to the address above along with a check or money order made payable to the
"Town of Wilmington".
If you are not sure that the record is on file in Wilmington, you may call us at (978) 658-2030 to confirm.
Your mail-in request will be processed the day it is received. Certified copies of the records may also be obtained in
person at the Town Clerk's office.
Name of Decedent: ____________________________________
Date of Death: _____________________________________
Parents Names:______________________________________
Number of Copies @ $10 each: _______________________
Your Name: _______________________________________
Address: ___________________________________________
City/State/Zip: _______________________________________
Signature: ___________________________________________
Phone or Email: ______________________________________
