Fillable For certified copies of death records for all (King County OIRM)

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For certified copies of death records for all (King County OIRM)

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BROWSE KING COUNTY OIRM (WA) FORMS

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For certified copies of death records for all who died within Seattle’s city limits, for
those who died in greater King County since 1944, and for all Washington State deaths
that have been filed electronically (starting in 2005).
Pursuant to the Revised Code of Washington 70.58.107, if we cannot fill your order because there is no matching record or because you cannot provide the
required information, we are required to charge you an $8 search fee instead of the $20 per certificate fee. In that case, we will provide a partial refund to you.
However, if your order is for a recent death, we will hold it until the funeral home has filed the certificate and fill your order at that time.
ACCOUNT HOLDER NAME AND MAILING ADDRESS
FACILITY NAME
ACCOUNT NUMBER
STREET ADDRESS
CONTACT NAME
CITY STATE ZIP CODE
DAYTIME PHONE
FOR RECORDS WITH CAUSE OF DEATH PENDING
ISSUE ALL COPIES REQUESTED IMMEDIATELY (these may not be exchanged free-of-charge with our office after the cause has posted)
WAIT UNTIL THE CAUSE OF DEATH IS ADDED BEFORE ISSUING THE REQUESTED COPIES
ISSUE OF THE REQUESTED COPIES IN PENDING STATUS, AND ISSUE COPIES WHEN THE CAUSE OF DEATH HAS BEEN ADDED
FAX THIS FORM TO: 206-897-4580
SPECIAL INSTRUCTIONS
OFFICE USE ONLY
Received
DC
V42
Index #
MDC
V32
NO COST
V20
DCS
V52
Issued
Mail Date
Front Counter Pickup
Paper #
Billed Account Death Certificate Order
REQUESTED CERTIFICATE
DECEDENT’S FIRST NAMES
DECEDENT’S MIDDLE NAMES
DECEDENT’S LAST NAMES
DATE OF DEATH (or up to a 10-year range)
PLACE OF DEATH (city or county)
AGE AT DEATH (if known)
NUMBER OF CERTIFIED COPIES REQUESTED:
CHECK TO REQUEST VA COPY
(INCLUDE DD-214 OR OTHER SEPARATION DOCUMENT)
King County Vital Statistics
www.kingcounty.gov/health/vitalstats
206-897-5100
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For certified copies of death records for all (King County OIRM)

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Completed 18 July 2020

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