In the meticulous world of handling essential documents, the PHS 520B form serves as a crucial tool for funeral directors to obtain certified copies of death certificates. Administered by the Department of Health and Hospitals (DHH) - Office of Public Health Vital Records Registry, this form provides a structured pathway for funeral directors to request these necessary documents post an individual's passing. With every detail meticulously outlined, from the information of the deceased to the requisite fees, the form ensures a seamless transaction for funeral homes. Integral to the process is the clear instruction on submitting the application alongside a check or money order, with a stark warning against the risks of submitting cash. Highlighting the importance of accuracy, the PHS 520B form delineates costs per certified copy, including subsequent copies at reduced rates, and even a charge for mail orders. It is constructed to streamline the sometimes emotionally taxing logistical aftermath of death, ensuring that all financial transactions are accounted for and that the requesting party is fully informed of the potential outcomes, including the retention of fees should no record be found. This detailed application process not only facilitates the necessary formalities but also underscores the sensitive balance between administrative rigor and compassionate service in times of loss.
| Question | Answer |
|---|---|
| Form Name | Form Phs 520B |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | ApplicationDeat h520B oph louisiana certification of death form |
DHH - OFFICE OF PUBLIC HEALTH
VITAL RECORDS REGISTRY
FUNERAL DIRECTOR'S APPLICATION FOR CERTIFIED COPY OF DEATH CERTIFICATE
SUBMIT COMPLETED APPLICATION and CHECK OR MONEY ORDER TO LA DHH / OPH / VITAL RECORDS REGISTRY. SUBMIT CASH AT YOUR OWN RISK. IF NO RECORD IS FOUND, FEES ARE RETAINED TO DEFRAY THE COST OF PROCESSING YOUR REQUEST AND YOU WILL BE INFORMED.
DEATH CERTIFICATE FOR: (Name at Death): _________________________________________________
(Date of Death): |
___________________________________________________ |
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(City or Parish): |
___________________________________________________ |
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FUNERAL DIRECTOR'S INFORMATION: |
|
NUMBER OF CERTIFIED COPIES REQUESTED: |
||
Funeral Home: __________________________ |
_____ Initial copy @ $9 |
= |
__________ |
|
Street or Route #: _______________________________ |
_____ Subsequent copies @ $7 |
= __________ |
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City, Zip Code: ________________________________ |
$.50 State charge for mail order = |
__________ |
||
|
|
Total = |
_________ |
|
Funeral Director's Signature: _________________________________
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PLEASE DO NOT WRITE IN THIS SPACE
Fees Received By ____________ Date _________ Cert. Audit Nos. ________ thru_________
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FOR MAIL SERVICE, PLEASE SUBMIT THIS FORM WITH YOUR CHECK OR MONEY ORDER TO: LOUISIANA VITAL RECORDS REGISTRY
P.O. BOX 60630
NEW ORLEANS, LOUISIANA 70160
MAIL CERTIFICATE(S) TO: NAME: ______________________________________
ADDRESS: ___________________________________
CITY/STATE/ZIP: _______________________________
PHS/520B (12/29/03)