180 S. Main St., Ste. 252, Martinsville, IN 46151

765-342-6621, Fax: 765-342-1062 morgancohd@morgancountyhealth.com

test wd

Application for Search of:*

Certified Copy of Death $15.00
Certified Genealogy Copy of Death $5.00
Print Out of Permanent Death Information $0.10 (Not Certified!)

To obtain a Certified Death Certificate, you must be able to complete the application in full and show proof that you have a direct interest (legal right) to the record and need the record to determine personal or property rights (IC 16-37-1-8). Example: Your name is on a vehicle title with the decedent; you have an insurance policy on the decedent listing you as beneficiary, etc.

Today's Date:*
Full Name of Deceased (First, Middle, Last):*
Date of Death:*
Place of Death:*
Your Relationship to Decedent:*
Applicant's Name:*
Applicant's Address:*
Phone:*
-
E-mail:*
Number of certificates required ($15.00 each):*
Total Amount ($) Paid to GovPay:*
GovPay Transaction Reference #:*

*** I.D. required. Please provide 1 copy of identification. You may scan your ID on top of your GovPay receipt, provided that you do not cover any of the writing on the receipt. ***

Upload a File for ID and the GovPay Receipt (jpg, jpeg, png, gif, doc, docx, xls, xlsx):*

By checking the box below, I hereby certify that I am the requestor named above and that I am authorized to request a certified copy of the record for the above named individual, in accordance with Indiana Code 16-37 and 410 Indiana Administrative Code 18. I understand that penalties are described by law for misrepresentation on this request.

I agree to the above statement:*

This office will only have death records for those persons who died in Morgan County, Indiana. If the person died in another county in Indiana, you may contact the local Health Department where the death occurred or contact the Indiana State Department of Health/ Vital Records to receive the record. If the person died outside of Indiana, you will need to contact officials in that jurisdiction for assistance.

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