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STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH (DPH)Request for a Certified Copy of a DeathCertificate from the Town of Death Vital Records OfficeVS39DTW Revised: 9/6/2011PLEASE PRINT×DO NOT MAIL

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Obtain the necessary request form for a certified document.

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Fill out the form completely and accurately with the required information.

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Submit the completed request form and any additional materials to the appropriate office or agency.

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Individuals who require a certified copy of a document for legal, official, or administrative purposes.

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Employers or organizations requesting verification of an individual's qualifications or credentials.

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A request for a certified is a formal application for a document or information to be verified by a reputable authority.

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The information required on a request for a certified may include personal details, document details, reason for certification, and any supporting documentation.

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