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Death Certificate Application


  1. 1. Agreement
  2. 2. Requestor
  3. 3. Shipping Information
  • Agreement

    1. You Understand That Your Order Will not be Processed Without Faxing or Emailing Your ID With Receipt Number.*

      Fax: 765-423-9797 Email: If you are a funeral home, please send a fax or email to notify the health department of your purchase.