DECEDENT'S INFORMATION:
First Name
Middle Name Last Name (at time of death) Date of Death
Place of Death
Village, Town or City of Birth
Full Maiden Name of Mother Father:
Purpose record is
required
Relationship
APPLICANT INFORMATION:
Full Name
Telephone Number
Address
Signature
_________________________________________
Date
City Clerk 255 Main Street White Plains, NY 10601 (914) 422-1227
Identification Requirements (One of the
following) IDENTIFICATION CANNOT BE
EXPIRED
Driver's License or Non-driver's license Passport or
Naturalization Papers
Military ID
Two (2) different (and current) utility bills showing
applicant's name and address
Police report of lost or stolen ID
Payment is $10.00 per copy. WE DO NOT ACCEPT
PERSONAL CHECKS. In person: Cash, money order,
Mastercard, Visa and American Express. By mail: Money
orders only made payable to "City of White Plains"
IN
ADDITION
TO:
Application for Death Record
1
2
3
4
Mail to: City Clerk
255 Main Street
White Plains, NY 10601
Additional Documentation Required
If you are a spouse and were married at the time of death, one of the
above mentioned IDs would suffice. Former spouses must provide a
certified copy of a marriage record.
If you are an adult child, you must present a certified copy of your
birth record which shows parents' names.
If you are a sibling, you must present a certified copy of your birth
record which shows parents' names.
Anyone who can demonstrate a legal claim or official medical
need, will need to have additional supporting documentation. Please
call our office for more information.
If you are an attorney, your request must be received on your law
firm stationary and payment must be in the form of a law firm check.
Mail requests are normally processed the day they are received
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