Arkansas Death Certificate Application Form PDF Details

Obtaining a death certificate in Arkansas requires completing the Death Certificate Application form as outlined by the Arkansas Department of Health. This crucial document is only applicable for deaths that occurred within the state, with records dating back, though limited, to before February 1, 1914. The initial fee for a certified copy is set at $10.00, with each additional copy costing $8.00. It's essential to send the exact fee with the application by check or money order, avoiding cash for safety reasons. Importantly, a portion of the fee, specifically $10.00, is non-refundable if the search does not yield the requested record, based solely on the names and dates initially provided. Any subsequent requests with added information will incur another non-refundable $10.00 fee. The form also requires submission of a copy of the requester's photo ID, to ensure security and prevent identity theft, detailed information about the deceased, including full name, date of birth, date of death, place of death, and the funeral home details, and the relationship and reason why the applicant is requesting the death certificate. Processing times can range from 4-6 weeks, underlining the need for timely submissions when a death certificate is required. Additionally, the form highlights alternative methods for ordering a certificate, including online, by phone, or in person, accommodating those who need expedited services. This process underscores the importance of accuracy and potential legal consequences for false statements, with penalties reaching up to $10,000 or imprisonment, emphasizing the serious nature of these applications.

QuestionAnswer
Form NameArkansas Death Certificate Application Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdeath certificate louisiana, blank ar certificate of death form, arkansas death certificates, death certificate arkansas

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ARKANSAS DEPARTMENT OF HEALTH

 

 

VITAL RECORDS, Slot 44

Date

 

4815 West Markham

 

 

Little Rock, AR 72205

 

 

DEATH CERTIFICATE APPLICATION

Only Arkansas deaths are recorded in this office. There are only a limited number of death records filed in this office for deaths prior to February 1, 1914. The fee is $10.00 for the first certified copy requested and $8.00 for each additional certified copy of the record. The fee must accompany the application. Send check or money order payable to the Arkansas Department of Health. DO NOT SEND CASH. Of the total fee you send, $10.00 will be kept to cover search charges if no record of the death is found. Only the names and dates listed will be searched for the $10.00 fee. Names and other dates submitted later will require an additional $10.00 non-refundable fee. Mail this application, a copy of your photo id and the money to the address above. Please allow 4-6 weeks for processing.

List Below All Possible Dates of Death and Names Under Which the Certificate May be Registered. (Type or Print)

1 Full Name of

First Name

Middle Name

 

Last Name

 

 

 

 

 

 

Deceased

 

 

 

 

 

 

 

 

 

 

 

 

Month

Day

Year

Age of Deceased

Sex

2Date of Death

3. Place Where

City or Town

County

State

Death Occurred

 

 

 

If unknown, give

 

 

 

City or Town

County

State

last place of

 

 

 

residence.

 

 

 

4.Name of Funeral Home

5.Address of Funeral Home

6.Name and Address of Attending Certifier

If deceased was an infant, was it stillborn?

Yes

No

What is your relationship to the person whose certificate is being requested?

What is your reason for requesting a copy of this certificate?

Signature and telephone number of person requesting this certificate:

X

HOW MANY

1st Copy costs $10.00

Each additional copy costs $8.00

AMOUNT OF MONEY ENCLOSED

$

All requests for certificates require photo identification.

Certificates may also be ordered by the following methods:

Internet: www.vitalchek.com. The service fee and the certificate fee are charged to your credit card (Visa, Master Card, Discover or American Express). Certificates may be returned over night for the additional shipment fee.

OR

Telephone: (866) 209-9482. The service fee and the certificate fee are charged to your credit card (Visa, Master Card, Discover or American Express). Certificates may be returned over night for the additional shipment fee.

OR

Please PRINT the name and address of the person who is to receive this request on the lines below.

Walk-in: You may order a certified copy of the death record by coming into this office. Orders are accepted for same day issuance from 8:00 A.M. until 4:00 P.M. Monday through Friday. The office is located at 4815 West Markham St. Little Rock, AR 72205.

Any person who willfully and knowingly makes any false statement in an application for a certified copy of a vital record filed in this state is subject to a fine of not more than ten thousand dollars ($10,000) or imprisoned not more than five (5) years, or both (Arkansas Statutes 20-18-105.)

VR-8 (R 8/11)

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Step # 1 of filling in arkansas death records 2021

2. The subsequent step would be to complete these particular blanks: Name and Address of Attending, Yes, What is your relationship to the, What is your reason for requesting, HOW MANY st Copy costs Each, All requests for certificates, Certificates may also be ordered, and Telephone The service fee and.

Writing section 2 of arkansas death records 2021

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