Please print and return the following application form:
Payment information is below. Send completed application and payment to:
Public Health Statistics
P.O. Box 1700
Jackson, MS 39215-1700
Instructions
Complete the information sections of this form. PLEASE PRINT.
The application must be signed.
Payment:
Send a personal check, bank or postal money order, or a bank cashier's
check in the correct amount made payable to Mississippi Vital Records.
We accept no responsibility for cash sent through the mail.
Failure to Receive
If your records fail to arrive, notify the Vital Records office. Complaints of failure to receive certified records will be honored within 6 months of the original request. If the copy was to
be returned to you by U. S. Postal Service, please allow 3 weeks after mailing the request before inquiring. Inquiry about copies ordered with
payment for special courier delivery should be made within 7 days of the request. Mail returned because of insufficient address or address
changes will be re-mailed if this office is notified of the correct address within 6 months of request.
Photo ID Requirement
If you are applying for yourself, or you are applying for someone else as their spouse, parent, grandparent,
sibling, child, grandchild, guardian, or legal representative, then you
must provide a completed application and a copy of your valid photo identification. Acceptable forms of identification are the following:
- State Issued Driver's License
- State Issued Photo ID
- Employment ID
- School, College or University ID
- US Military ID
- Tribal ID
- Alien Registration/Permanent Resident Card
- Temporary Resident Card
- US Passport
Guardian or legal representative must submit proof of guardianship/legal representation
with this application. Legal representatives must provide attorney bar number,
name of person represented, and their relationship to the registrant. If you
are an agent of a local, state or federal agency requesting a record, indicate
in the space provided for "relationship" the name of the agency.
Information
Only deaths recorded after November 1, 1912, are on file. For earlier records, contact the Department of Archives & History.
The death certificate is the most important legal document in the settlement
of the estate and insurance. It is important that the information on the certificate is
correct. When you receive copies of the death certificate, check particularly spelling of
names and that dates are correct.
If there are incorrect items on the certificate and the death occurred less
than one year ago, please notify the funeral director who filed the certificate.
If there are incorrect items on the certificate and the death occurred more
than one year ago, a court order may be required. Please contact Vital Records at
the above address for additional information.
The fee for a certified copy of a death certificate is $15.00. Each additional
copy ordered at the same time costs $5.00.
A five-year search of our records will be made. If the record is not on file,
only the fees paid for any additional copies, if any, will be refunded.
For more information: e-mail VRInfo@msdh.state.ms.us or contact our Vital Records office at (601) 576-7981.
