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Blank Arkansas Death Certificate Application Form

The Arkansas Death Certificate Application form is a crucial document for obtaining certified copies of death records for individuals who passed away in Arkansas. This form is essential for legal, genealogical, or personal purposes and can only be used for deaths recorded after February 1, 1914. If you need to request a death certificate, please fill out the form by clicking the button below.

Prepare Arkansas Death Certificate Application

Prepare Arkansas Death Certificate Application

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Free Arkansas Death Certificate Application File

Form Properties

Fact Name	Details
Office Location	Arkansas Department of Health Vital Records, Slot 44, 4815 West Markham, Little Rock, AR 72205
Record Limitation	Only Arkansas deaths are recorded. Limited records exist for deaths prior to February 1, 1914.
Application Fee	The fee is $10.00 for the first certified copy and $8.00 for each additional copy.
Payment Method	Payment must be made via check or money order payable to the Arkansas Department of Health. Cash is not accepted.
Search Charge	$10.00 will be kept to cover search charges if no record is found. Only names and dates submitted will be searched for this fee.
Processing Time	Allow 4-6 weeks for processing after submission of the application and payment.
Identification Requirement	A copy of photo identification is required with the application for all requests.
Governing Law	False statements in applications may lead to a fine up to $10,000 or imprisonment up to 5 years (Arkansas Statutes 20-18-105).

Key takeaways

Understanding the Arkansas Death Certificate Application form is essential for a smooth process. Here are some key takeaways:

The application only covers deaths that occurred in Arkansas. If the death happened elsewhere, you will need to contact the appropriate state office.
There is a fee of $10.00 for the first certified copy and $8.00 for each additional copy. Ensure you include the correct payment with your application.
Include a copy of your photo ID when mailing your application. This is necessary to verify your identity.
Processing time can take 4-6 weeks, so plan accordingly if you need the certificate by a specific date.
Requests can also be made online or by phone, but these methods may incur additional service fees. You can also visit the office in person for same-day issuance during business hours.

Detailed Steps for Using Arkansas Death Certificate Application

Filling out the Arkansas Death Certificate Application form requires careful attention to detail. Once completed, you will need to submit the form along with the required payment and identification. Processing typically takes four to six weeks, so plan accordingly.

Obtain the Arkansas Death Certificate Application form from the Arkansas Department of Health or their website.
Fill in the full name of the deceased, including first name, middle name, and last name.
Enter the date of death using the format Month, Day, Year.
Provide the age and sex of the deceased.
Indicate the place of death by listing the city or town, county, and state. If unknown, provide the last place of residence.
Write the name and address of the funeral home involved.
Include the name and address of the attending certifier.
If the deceased was an infant, indicate whether it was stillborn by selecting "Yes" or "No."
State your relationship to the deceased.
Explain your reason for requesting the certificate.
Sign the application and provide your telephone number.
Calculate the total amount of money enclosed, ensuring to include $10.00 for the first copy and $8.00 for each additional copy.
Attach a copy of your photo identification to the application.
Mail the completed application, payment, and ID to the Arkansas Department of Health at the provided address.

Common mistakes

Completing the Arkansas Death Certificate Application form can be straightforward, but several common mistakes can lead to delays or complications. One frequent error occurs when applicants fail to provide all possible names under which the deceased may be registered. It is crucial to include variations in spelling or any nicknames to ensure a thorough search.

Another mistake is neglecting to list all potential dates of death. If the exact date is uncertain, providing a range of dates can help the processing team locate the correct record. Omitting this information can result in additional fees for subsequent searches.

Applicants often overlook the requirement for photo identification. Submitting the application without a valid ID can lead to immediate rejection. It is essential to include a clear copy of your identification to avoid unnecessary delays.

Inaccurate information about the deceased's place of death is another common issue. If the city or county is unknown, applicants must provide the last known residence. Failing to do so can hinder the search process and result in additional fees.

Many people also forget to include the payment for the application fee. The initial fee is $10.00 for the first copy, and $8.00 for each additional copy. If the payment is missing, the application will not be processed, causing frustration and further delays.

Additionally, individuals sometimes fail to sign the application. A missing signature can lead to the application being deemed incomplete. It is vital to ensure that the signature is present and matches the name of the person requesting the certificate.

Providing an incorrect telephone number can also create problems. The contact number is essential for any follow-up questions or clarifications needed by the processing team. Make sure the number is accurate and current.

Some applicants may not specify their relationship to the deceased. This information is necessary for the processing team to verify eligibility for obtaining the death certificate. Omitting this detail can lead to confusion and delays.

Lastly, applicants sometimes neglect to check the mailing address for accuracy. An incorrect address can result in the certificate being sent to the wrong location, causing further complications. Double-checking the address before submission can save time and effort.

Arkansas Death Certificate Application Sample

		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
1 Full Name of
Deceased

	Month	Day	Year	Age of Deceased	Sex

2Date of Death

3. Place Where	City or Town	County	State
Death Occurred
If unknown, give
If unknown, give	City or Town	County	State
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

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:

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.

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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