> Public Health > Vital Records > Death Certificates > Certificate Application

Certificate Application

In-Person:

If you are an authorized individual (see application below), you may come into our office to purchase a certified death certificate. In order to receive an authorized, certified copy, you must complete the application form, which includes a sworn statement, under penalty of perjury. You may bring valid identification, i.e. state identification, state driver's license, passport, etc. Pay by cash, check or money order only, payable to Lake County Health Services Department.
Do Not Sign the sworn statement until you are in the presence of VR staff.
Forms:
Application (en)
Application (sp)
Sworn Statement (en)
Sworn Statement (sp)

By Mail:

A completed application and a notarized sworn statement form signed under penalty of perjury by the authorized requestor are required for all orders sent by mail. Mail the notarized application and the required payment by check and money order only, payable to Lake County Health Services Department.
Forms:
Application (en)
Application (sp)
Sworn Statement (must be notorized (en)
Sworn Statement (must be notorized (sp)
Mail to:
Lake County Health Services Department Vital Records
922 Bevins Court
Lakeport, CA 95453