The Arkansas Death Certificate Application form is a document used to request certified copies of death records for individuals who passed away in Arkansas. This form must be completed and submitted to the Arkansas Department of Health, along with the appropriate fees and identification. It is important to note that only deaths occurring after February 1, 1914, are recorded in this office, and specific guidelines must be followed to ensure successful processing of the application.
Obtaining a death certificate in Arkansas involves a straightforward application process that is essential for various legal and personal reasons. The Arkansas Death Certificate Application form is specifically designed for recording deaths that occur within the state. It is important to note that the office only maintains records for deaths that occurred after February 1, 1914, with a limited number of exceptions for earlier records. The application requires a fee of $10.00 for the first certified copy, with additional copies available for $8.00 each. This fee must accompany the application, which can be submitted via mail, online, or in person at the designated office in Little Rock. When completing the application, individuals must provide detailed information about the deceased, including their full name, date of death, place of death, and other relevant details. Additionally, applicants are required to include a copy of their photo identification. The form also prompts users to specify their relationship to the deceased and the purpose of the request. Processing times typically range from four to six weeks, so planning ahead is advisable. For those who need immediate access, walk-in services are available during business hours for same-day issuance. Understanding the requirements and procedures outlined in the application can facilitate a smoother experience in obtaining this vital record.
The fee for the first certified copy of a death certificate is $10.00. Each additional certified copy costs $8.00. This fee must accompany your application. If no record of the death is found, $10.00 will be retained to cover search charges.
You can apply for a death certificate by mailing your application, a copy of your photo ID, and the appropriate fee to the Arkansas Department of Health at 4815 West Markham, Slot 44, Little Rock, AR 72205. Alternatively, you can apply online through VitalChek or by calling (866) 209-9482.
Your application should include the following details:
Please allow 4 to 6 weeks for processing your application. If you need the certificate sooner, consider visiting the office in person during business hours for same-day issuance.
Yes, you can apply in person at the Arkansas Department of Health office located at 4815 West Markham St., Little Rock, AR 72205. Walk-in requests are accepted from 8:00 A.M. to 4:00 P.M., Monday through Friday.
If you are unsure of the exact date of death, you should list all possible dates and names under which the certificate may be registered. Each additional name or date will require a new $10.00 non-refundable fee.
Payments should be made by check or money order payable to the Arkansas Department of Health. Do not send cash. If applying online or by phone, credit cards such as Visa, MasterCard, Discover, or American Express are accepted.
All requests for death certificates require a copy of your photo identification. This ensures that the request is legitimate and protects the privacy of the deceased and their family.
Providing false information on your application can lead to serious consequences. Individuals who willfully make false statements may face a fine of up to $10,000 or imprisonment for up to five years, or both.
Yes, if you apply online or by phone, you can request overnight shipping for an additional fee. This can significantly reduce the time it takes to receive the certificate.
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.)
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When filling out the Arkansas Death Certificate Application form, it is important to follow certain guidelines to ensure a smooth process. Below is a list of things you should and shouldn't do:
By adhering to these guidelines, you can help facilitate the processing of the death certificate application in Arkansas. It is always best to double-check your application before submission to avoid any delays.
Filling out the Arkansas Death Certificate Application form can seem straightforward, but there are common mistakes that can delay the process or even lead to complications. Here’s a list of seven mistakes to watch out for:
By being mindful of these common pitfalls, you can help ensure that your application for a death certificate is processed smoothly and efficiently.