Form DH 1961 at a glance
What it is: Application for a Florida Death Record, DH 1961.
Where and when to file: MAILING ADDRESS: St. Johns County Health Department 1955 U.S. 1 South, Suite 100 St. Augustine, FL 32086 904-825-5055 ext 1001 Your order will be processed as soon as your request is received if all information is correct and identification can clearly be read.
Any person of legal age (18) may be issued a death certification without the cause of death.
Cause of Death for any record over 50 years old may be issued to any applicant.
Death records less than 50 years old with the cause of death information included may only be issued to the following individuals: Decedent's spouse or parent; Decedent's child, grandchild or sibling, if of legal age; Any person who provides a will, insurance policy or other document that demonstrates his or her interest in the estate of the decedent, OR Any person who provides documentation that he or she is acting on behalf of any of the named persons.
What to bring and attach to Form DH 1961
Read the FRONT AND BACK of this application: Anyone may apply for a death certification. When cause of death information is also requested and the death occurred less than 50 years ago, a valid photo identification must accompany this application or if a mail request, a copy of the valid photo identification, front & back, must be provided; AND the applicant OR person being represented must be an eligible person as outlined in statute (see Eligibility on the back of this form). Relationship to the decedent must be entered in the space provided at the bottom of this form when requesting cause of death. If applicant is a funeral director or an attorney, see additional information under Eligibility on back of this form to ensure proper completion of this application. Acceptable forms of valid ID are: driver's license, state identification card, passport, and/or military ID card. When requesting a death certification without cause of death OR if the death occurred over 50 years prior to the request, photo identification is not required.
A filled-in Form DH 1961 example: a spouse asks for the cause of death
How to fill out Form DH 1961, box by box
Name of decedent
NAME OF DECEDENT: FIRST MIDDLE LAST SUFFIX, and ALIAS NAME (IF APPLICABLE)
A search cannot be made without the decedent's name and year of death.
If any of the other items requested on the front of this form are unavailable, other identifying information (such as parents' names, birthplace, etc) may be helpful if multiple records are found for common names.
IF MARRIED FEMALE, MAIDEN SURNAME (if known)
Date of death
DATE OF DEATH: MONTH DAY YEAR (4-DIGIT); ADDITIONAL YEARS TO BE SEARCHED (Required only when exact year of death is not known). Indicate the range of years to be searched
Place of death
PLACE OF DEATH: CITY OR TOWN PLACE OF DEATH COUNTY STATE FILE NUMBER (if known)
Surviving spouse, Social Security number and funeral home
NAME OF SURVIVING SPOUSE AS RECORDED ON DEATH RECORD (if applicable and if known)
SOCIAL SECURITY NUMBER (if known) and FUNERAL HOME NAME (if known)
Section B: Applicant information
SECTION B: APPLICANT INFORMATION: MAILING ADDRESS (INCLUDE APT. NO., IF APPLICABLE) and RELATIONSHIP TO DECEDENT. If requesting cause of death, all applicants must state their relationship to the decedent; if a funeral director or an attorney, you must enter the relationship of the person you represent.
Applicant's signature is required, as well as his/her name, valid residence address and telephone number.
Funeral Director/Attorney as Applicant for Cause of Death Information
Funeral Director/Attorney as Applicant for Cause of Death Information: LICENSE/ BAR NUMBER, NAME OF PERSON REPRESENTED and THEIR RELATIONSHIP TO DECEDENT
A funeral director or attorney representing an eligible person must include their professional license number, and the name and relationship of the person they are representing, if requesting cause of death.
If not representing someone identified as eligible to receive cause of death information, then a completed Affidavit to Release Cause of Death Information (DH 1959) must accompany this request.
Number of copies and Total Due
Number of copies: WITH cause of death or WITHOUT cause of death, $10.00 Each (checked November 1, 2026). No personal checks. $10.00 Rush fee (Faxed orders only) (checked November 1, 2026). Total Due.
RUSH ORDER: Fax this completed application form, valid picture identification (enlarged 200% and lightened) and credit card authorization forms to 904-823-4062.
More rules for Form DH 1961
SPECIAL NOTE: Florida clerks of court will not accept a death record with cause of death information included when filing probate.
Common questions about Form DH 1961
Does it need a notary?
Requests for a death certification that includes the cause of death information must state the qualifying eligibility, or a notarized Affidavit to Release Cause of Death Information (DH 1959), which is available upon request.
Where do I file it?
MAILING ADDRESS: St. Johns County Health Department 1955 U.S. 1 South, Suite 100 St. Augustine, FL 32086 904-825-5055 ext 1001
Is there a penalty?
Any person who willfully and knowingly provides any false information on a certificate, record or report required by Chapter 382, Florida Statutes, or on any application or affidavit, or who obtains confidential information from any Vital Record under false or fraudulent purposes, commits a felony of the third degree, punishable as provided in Chapter 775, Florida Statutes.
Sources
[1] Form DH 1961 (6/13), Application for a Florida Death Record, St. Johns County Health Department, Florida Department of Health (the Official source link on this page).