APPLICATION FOR AN MICHIGAN DEATH RECORD AUTHENTICATED OR APOSTILLED COPY INFORMATION ABOUT AUTHENTICATED CERTIFICATES - Authenticated (exemplified or containing an apostille) records are typically required by foreign governments for an adoption, work visas, marriage in a foreign country, or establishing residency. You must specify which country requires the document. Applying the “apostille” at the Secretary of State’s Office of the Great Seal takes an additional 2-3 weeks after processing in Vital Records is completed. PART 1: APPLICANT’S INFORMATION (Person Requesting Record) Applicant’s Name:______________________________________________________________________________________________ Mailing Address: ______________________________________ City: ____________________ State: _____ Zip: ________ Daytime Phone ( PART 2: ) ________________________________ Other Phone: ( ) ________________________________ CERTIFICATION OF INFORMATION PROVIDED By signing this application, I understand that I am agreeing to pay for a search of the State of Michigan Vital Records with the information that I provided. This does not guarantee that a record will be found. ► Applicant’s Signature: _________________________________ Date: __________ PART 3: PURPOSE FOR REQUESTING THE RECORD PART 4: SPECIFY COUNTRY OF USE PART 5: DEATH INFORMATION NEEDED TO FIND THE RECORD If the exact date of death is unknown, please indicate the year you want searched. If you need additional years searched, please see Part 6 payment box for fee information. We can do a search without the “county” of death, but it may not be a thorough search. NAME OF DECEASED (Name at time of death) DATE OF BIRTH (If Known) First GENDER □ □ Male Middle Last (mm/dd/yyyy) DECEDENT’S PLACE OF DEATH Female DATE OF DEATH mm/dd/yyyy) Other variations of same name or locations: City County State Please provide any of the following additional information (if known) that would help us locate the death record: DECEDENT’S PLACE OF BIRTH DECEDENT’S SOCIAL SECURITY NUMBER State Country DECEDENT’S MOTHER’S NAME ___ ___ ___ ___ ___ ___ ___ ___ ___ DECEDENT’S FATHER’S NAME First Middle Last First Middle Last PART 6: FEES - Includes one certified copy or no-find letter Base Fee: Includes One Year Search $42.00 $ 42.00 Additional Certified Copies (Each) ____ x $26.00 $ Additional Years Search (Number of years) ____ x $12.00 $ (when exact year unknown) Indicate years you want searched: _____ _____ _____ _____ EXPEDITED “RUSH” SERVICE (Additional) $25.00 $ For Accounting Use Only PAYMENT TO “STATE OF MICHIGAN” TOTAL: Is your request complete? See checklist on back! American LegalNet, Inc. www.FormsWorkFlow.com HAVE YOU DOUBLE CHECKED ??        PART 1: Print your name and mailing address Cannot send to general delivery addresses Include a telephone number to reach you PART 2: Sign your name Do not print. Signature required. PART 3: Fill out purpose for requesting the record PART 4: Specify COUNTRY of use PART 5: Complete all items “Unknown” if information unavailable “N/A” if not applicable PART 6: Fees Please total all fees correctly PAYMENT Check or money order made payable to the “State of Michigan” APPLYING IN PERSON LOCATION: Capitol View Building, 3rd Floor 201 Townsend Street Lansing MI 48913 (across from the State Capitol) LOBBY HOURS: 8:00 am - 5:00 pm M-F except for recognized state holidays. DIRECTIONS: Visit our website at: www.michigan.gov/ vitalrecords or call 517-335-8666. SAME DAY SERVICE: Same day service is not available for an authenticated record; however, you do have the option of requesting a regular certified copy ($46 order placed before 2:00 pm) and then personally walking it to the Office of the Great Seal (2 blocks) to have the apostille affixed. Please allow up to a 2 hour waiting period for the order to be processed in our office. Genealogy requests may take longer. PROCESSING TIMES FOR MAIL REQUESTS REGULAR SEARCH – The processing time for a regular request will be approximately 5 weeks, depending on the volume of requests received. EXPEDITED (RUSH) SEARCH – The processing time for a “rush” request will be approximately 2 weeks, depending on the volume of requests received. APOSTILLES - Applying the apostille at the Secretary of State’s Office of the Great Seal for any request takes an additional 2-3 weeks after processing in Vital Records is completed. If you request just a certified copy from our office before 2:00 pm, you can go in person (two blocks) and have the apostille applied same-day. ADDITIONAL INFORMATION - If you find that the processing times listed do not meet your needs, please call our Eligibility Unit at 517335-8666 and speak with a customer service representative. They may be able to offer additional help to meet your individual situation. MAIL APPLICATION TO REGULAR MAIL TO: Vital Records Requests PO Box 30721 Lansing MI 48909 RUSH MAIL TO: Vital Records RUSH PO Box 30721 Lansing MI 48909 REQUESTING A MICHIGAN DEATH RECORD The Michigan Vital Records office has records of deaths that occurred in Michigan and were filed with the state since 1867. Occasionally, some of the records were not filed with the state; more records are missing from the pre-1906 files. Death records are not restricted documents in Michigan. Anyone can request that a search be conducted if the application is completed and signed, and submitted with the required fee paid. PAYMENT: A money order, credit card or cash can be used at our front counter. A personal check can also be used if the request is NOT same-day service. PAYMENT INFORMATION SEARCH FEES ARE NON-REFUNDABLE: Fees are established by state statute. The base fee includes a statewide search of one year and either one certified copy of the record or an official statement that the record is not filed with the state. REFUNDABLE FEES: Payment for additional copies will be refunded if the search indicated that the record is not filed with the state. A refund check would be mailed to you by the Michigan Department of Treasury, usually within 3-6 weeks. RUSH SERVICE: Applies to processing time in Vital Records. For a mail-in request, applying the “apostille” at the Office of the Great Seal takes an additional 2-3 weeks after processing in Vital Records is completed. www.michigan.gov/vitalrecords 517-335-8666 DCH-0569-DX-AUTH Rev 11-2015 By Authority of MCL 333.2882(1)©, MCL 333.2883(2) and MCL 333.2891(1-4) American LegalNet, Inc. www.FormsWorkFlow.com