Death records are available from 1905 - Present.
Certificates may be ordered online at vitalrecords.utah.gov.
Please read this application carefully. It is a criminal violation to make false
statements on this application or to fraudulently obtain a vital records certificate.
All fees paid are non-refundable. If required information is missing from this
application, applicant will have 90 days to provide missing information.
[ ] This application is fully completed.
[ ] Payment is ready // Mail: Check or Money Order to 'Vital Records' is enclosed
[ ] My ID is ready. (See reverse for ID list) // Mail: Copy of ID enclosed
FULL NAME OF DECEASED ______________________________________________________________________________
DATE OF DEATH ________________ CITY _____________________________ COUNTY ________________________
BIRTH DATE ____________________ BIRTH STATE OR COUNTRY ______________________________________________
DECEDENT'S SPOUSE NAME IF MARRIED _________________________________________________________________
PARENT 1 NAME ________________________________ PARENT 2 NAME _______________________________________
RELATIONSHIP TO DECEDENT: [ ] Parent [ ] Sibling [ ] Spouse [ ] Child [ ] Grandparent [ ] Grandchild
[ ] Other (requires documentary proof of relationship or legal need) Specify: ____________________________________________________
PRINTED NAME _______________________________________________________ PHONE _________________________
ADDRESS _____________________________________________________________________________________________
EMAIL ADDRESS _______________________________________________________________________________________
PURPOSE CERTIFICATE IS NEEDED: _______________________________________________
[ ] Needed to secure VA benefits
NUMBER OF CERTIFICATES 1 Search (non-refundable) includes 1 certified copy $30 +
Additional certified copies ($10 each) =
TOTAL FEE
SIGNATURE ___________________________________________________________ DATE ___________________________
ID # ______________________________ ID Exp __________ Request # ____________________________
Paid: Check Money Order Cash Credit Card Account Clerk Initials ______
MAILING ADDRESS: PO Box 141012 ◦ SLC, UT 84114-1012 ◦ PHYSICAL ADDRESS: 288 N 1460 W, SLC
801-538-6105 ◦ Fax 801-538-7012 ◦
[email protected] ◦ vitalreco
rds.utah.gov ◦ UDOH-OVRS-200 April 2021