[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-280616-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-280616-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","death-application-for-certified-copy-of-maryland-death-record","Death Application for Certified Copy of Maryland Death Record","","Death Application form for requesting a certified copy of a Maryland death record from the Charles County Department of Health. The form collects applicant identity, signature, relationship to the decedent, and decedent details including date of death, age, sex, and place of death. It specifies eligibility requirements, mandatory photo ID or alternative proof documents, and enumerates ordering information, fees, payment methods, and mailing/address handling. It also notes limited fee exemptions and provides contact options for additional record requests.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/death-application-for-certified-copy-of-maryland-death-record/280616/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/death-application-for-certified-copy-of-maryland-death-record/280616.png","ImageObject",442,249,{"name":42,"@type":43},"Pentious","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-03","2026-09-16",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Who is eligible to request a certified copy of a Maryland death record?","Question",{"text":63,"@type":64},"A copy may be issued only to applicants with a direct and tangible interest in the record as described by COMAR 10.03.08.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What identification must be provided with the application?",{"text":68,"@type":64},"A legible copy of a valid government-issued photo ID is required. If no government-issued photo ID is available, the applicant must sign a statement and submit two acceptable documents that show name and current address.",{"name":70,"@type":61,"acceptedAnswer":71},"How much do certified copies cost and how can payment be made?",{"text":72,"@type":64},"$25 is charged for the first paid copy and $20 for each additional copy in the same transaction. Payment methods include cash, check, money order, Visa, or MasterCard, with checks payable to Charles County Department of Health.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},280616,1789552759,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":80,"read_time":4},1374404730887,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","DEATH Application for Certified Copy of Maryland Death Record DEATH  \nCharles County Department of Health  \nBy my signature below, I state that I am the person I represent myself to be herein, and I affirm that the information submitted on this form is complete and accurate and submitted subject to the criminal penalties set forth at Maryland Code Annotated, Health-General Section 4-227.  \nSignature of person making request:   Date of Application:    \nFor Issuing Office Only  \n􀂉 Photo ID 􀂉 Mailed  \nNOTE: A copy of a death certificate may only be issued to applicants who have a direct and tangible interest in the content of the record as described in Code of Maryland Regulations (COMAR) 10.03.08.  \nPRINT or type YOUR name & CURRENT address.  \nYour relationship to the person  \nName:   named on the Certificate:    \nAddress:   City:   State:   Zip:   Daytime phone number: ( )   -   E-mail Address:    \nPHOTO ID REQUIRED: The individual requesting the record should submit a legible copy of his/her VALID GOVERNMENTISSUED PHOTO ID with completed application. (Examples: State issued driver’s license or non-driver photo ID with requestor’s current address; passport). If you do not have a Government-issued photo ID, read and sign the following statement: I declare that Ido not have a government-issued photo ID and that I am presenting the attached two documents that include my name and current address as proof of identification. (Note: These documents must include two of the following: Social Security card, utility bill, car registration form, pay stub, bank statement, copy of income tax return/W-2 form, letter from a government agency requesting a vital record, or lease/rental agreement. Please submit photocopies since these documents will not be returned to you. If you do not have a Government-issued photo ID, the certificate(s) will be mailed to the address listed on the documents that you present.)  \nSignature:    \nPRINT or TYPE information below with regard to the individual named on the requested certificate:  \nName of Decedent:    \nDate of Death:   Age at death:   Sex: □ Male □ Female  \n(Month/Day/Year)  \nPlace of Death:    \n(County or Baltimore City)  \nName of funeral home:   Reason for requesting certificate:    \n| Number of\u003Cbr>certificates requested |  |\n| --- | --- |\n| Fee for first\u003Cbr>paid copy* | $25 |\n| Fee for each additional copy | $20 |\n| Amount\u003Cbr>enclosed |  |\n\nORDER INFORMATION  \nYou may apply for a death certificate copy at the health department in person only. There is a non– refundable fee of $25 for the first copy of a death certificate purchased in a single transaction. * There is a fee of $20 for each additional copy of the same certificate purchased in the same transaction. Methods of payment are cash, check, money order, Visa or MasterCard. Checks should be made payable to Charles County Department of Health (or CCDH) . When paying by check, you must include a copy of your driver’s license or other government-issued photo ID that lists your current address, or other acceptable ID as noted above.  \nYou may also apply for a death record in person, by mail, on line, by telephone or by fax, at the Division of Vital Records in Baltimore. For further information, visit the Vital Statistics Administration website at [https://health.maryland.gov/vsa or](https://health.maryland.gov/vsa or) call 410-764-3038.  \n*There is no fee for: (a) A copy of a certificate of a current or former armed forces member that is requested by the member; or (b) A copy of a certificate of a current or former armed forces member or of a surviving spouse or child of the member, if the copy will be used in connection with a claim for a dependent or beneficiary of the member. Proof of service in the armed forces must be provided.  \nTo obtain death records for genealogical purposes, contact the Maryland State Archives in Annapolis (telephone number 410-260-6400) or on line at [https://msa.maryland.gov](https://msa.maryland.gov).  \nRev. 05/18","cbCaibDrMSUrhgBd","https://ap.wps.com/l/cbCaibDrMSUrhgBd","pdf",178630,"English","# Death Application for Certified Copy of Maryland Death Record\n## Applicant declaration and issuing office options\n## Eligibility note and photo ID requirements\n## Decedent information and requested certificates\n## Fees, payment methods, and ordering information\n## Exemptions and contact details","[{\"question\":\"Who is eligible to request a certified copy of a Maryland death record?\",\"answer\":\"A copy may be issued only to applicants with a direct and tangible interest in the record as described by COMAR 10.03.08.\"},{\"question\":\"What identification must be provided with the application?\",\"answer\":\"A legible copy of a valid government-issued photo ID is required. If no government-issued photo ID is available, the applicant must sign a statement and submit two acceptable documents that show name and current address.\"},{\"question\":\"How much do certified copies cost and how can payment be made?\",\"answer\":\"$25 is charged for the first paid copy and $20 for each additional copy in the same transaction. Payment methods include cash, check, money order, Visa, or MasterCard, with checks payable to Charles County Department of Health.\"}]","Death Application for Certified Copy of Maryland Death Record | PDF"]