The Arkansas Death Certificate Application form is a document used to request certified copies of death records for individuals who passed away in Arkansas. This form is essential for obtaining vital records, which may be needed for legal, financial, or personal reasons. To begin the process, please fill out the application by clicking the button below.
The Arkansas Death Certificate Application form is a crucial document for anyone needing to obtain a certified copy of a death record in the state. This form is specifically designed for deaths that occurred in Arkansas, and it is important to note that only a limited number of records are available for deaths prior to February 1, 1914. The application process involves a fee structure where the first certified copy costs $10.00, while each additional copy is priced at $8.00. It is necessary to submit the fee along with the application, using a check or money order made out to the Arkansas Department of Health. Cash should not be sent. If the search does not yield a record, the initial $10.00 fee will still be retained to cover search costs. The form requires detailed information, including the deceased's full name, date of death, place of death, and the name of the funeral home involved. Additionally, applicants must provide a copy of their photo ID and specify their relationship to the deceased, as well as the reason for the request. For convenience, requests can also be made online or via telephone, with options for same-day issuance available for in-person visits at the designated office in Little Rock. Understanding these requirements can help streamline the process of obtaining a death certificate during a difficult time.
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
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.
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.)
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