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Death Certificates

Death certificates and permits for disposition of human remains are usually prepared by a funeral director and signed by a physician. The law is very strict about who may request and receive authorized, certified copies of death certificates. Its intent is to protect an individual's privacy and keep their personal information safe from identity theft. Only those listed in the application are authorized to obtain certified copies of birth/death certificates:
  • The registrant or a parent or legal guardian of the registrant.
  • A party entitled to receive the certificate as a result of a court order, or an attorney or a licensed adoption agency seeking the death certificate in order to comply with the requirement of Section 3140 or 7603 of the Family Code.
  • A member of a law enforcement agency or a representative of another governmental agency, as provided by law, who is conducting official business (companies representing a government agency must provide authorization from the government agency).
  • A child, grandparent, grandchild, sibling, spouse or domestic partner of the registrant.
  • An attorney representing the registrant or the registrant's estate, or any person or agency empowered by statute, or appointed by a court to act on behalf of the registrant or the registrant's estate.
  • Any agent or employee of a funeral establishment who acts within the course and scope of his or her employment and who orders certified copies of a death certificate on behalf of any authorized individual specified above or in Health and Safety Code Section 7100.
Informational Only copies of death certificates
Those who do not meet the criteria for an authorized certified copy may receive an informational only copy. The words "informational, not a valid document to establish identity" will be imprinted across the face of the certified copy.

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Violent, Sudden or Medically Unattended Death
The Medical Examiner-Coroner (MEC) is responsible to investigate all violent, sudden or medically unattended deaths within the county. If autopsy/ toxicology reports are not immediately available, a death certificate may be prepared with the causes listed as "Pending or Under Investigation". Once the cause-of-death is known, the MEC submits an amendment for registration. Contact the MEC office for more information or timelines at (707) 262-4215.
Application Process
If applying 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.
Reminder: Do Not Sign the sworn statement until you are in the presence of VR staff.

InPersonIn-Person Forms:
Application (en)
Application (sp)
Sworn Statement (en)
Sworn Statement (sp)

If applying 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.

InPersonMail-in 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

Changing a Death Certificate

If there is incorrect or missing information on a death certificate, you may make a request for an amendment. The Office of Vital Statistics can assist in preparing or requesting amendments to death certificates for all years.
The following forms and instruction are available:
Affidavit to Amend a Death Record
Court Ordered Delayed Registration of Death

Not sure which form you need? Call the Office of vital Statistics at (707) 263-1090 for more information.