The Arkansas Death Certificate Application form is a crucial document for obtaining certified copies of death records within the state. This application is specifically for deaths that occurred in Arkansas, with limited records available for events prior to February 1, 1914. Completing this form accurately is essential to ensure timely processing of your request.
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When filling out the Arkansas Death Certificate Application form, consider the following guidelines:
Additionally, avoid these common mistakes:
To apply for a death certificate in Arkansas, you must complete the Arkansas Death Certificate Application form. This form requires specific information, including the deceased's full name, date of death, place of death, and your relationship to the deceased. You will also need to provide a copy of your photo ID and include the appropriate fee. The fee is $10.00 for the first certified copy and $8.00 for each additional copy. Once you have completed the form and gathered the necessary documents, mail everything to the Arkansas Department of Health at the address provided on the form. Alternatively, you can apply online or by phone for added convenience.
After submitting your application, you should allow 4 to 6 weeks for processing. This timeframe can vary based on the volume of requests received by the Arkansas Department of Health. If you need the certificate more urgently, you might consider applying in person during business hours, as same-day issuance is available at the office.
If you are unsure of the exact date of death, you should list all possible dates along with the names under which the certificate may be registered. This will help the office conduct a thorough search. Keep in mind that the initial search fee of $10.00 only covers the names and dates you provide. If you need to submit additional names or dates later, another non-refundable fee of $10.00 will be required for each search.
Yes, you can apply for a death certificate online through the website www.vitalchek.com or by calling (866) 209-9482. When applying through these methods, the service fee and the certificate fee will be charged to your credit card. If you need the certificate quickly, both services offer options for overnight shipping at an additional cost.
All requests for a death certificate require photo identification. Acceptable forms of ID include a driver’s license, state ID, or passport. This is to ensure that the request is being made by an authorized individual. Without proper identification, the application may be delayed or denied.
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.)
VR-8 (R 8/11)