Homepage Blank Arkansas Death Certificate Application Form
Outline

Navigating the process of obtaining a death certificate in Arkansas can feel overwhelming, especially during a time of grief. The Arkansas Death Certificate Application form is designed to streamline this process, ensuring that families can access the vital records they need. This form is specifically for deaths that occurred in Arkansas, and it is important to note that records prior to February 1, 1914, are limited. When completing the application, you will need to provide essential information such as the deceased's full name, date of death, and place of death. The application requires a fee of $10 for the first certified copy, with additional copies available for $8 each. Payment must accompany the application, and only checks or money orders made out to the Arkansas Department of Health are accepted—cash should never be sent. Along with the completed form, a copy of your photo ID is necessary, and it is advisable to allow four to six weeks for processing. For those who prefer a quicker option, certificates can also be ordered online or by phone, with same-day issuance available for walk-in requests at the office in Little Rock. It is crucial to approach this process with honesty, as providing false information can lead to severe penalties. Understanding these details can help ease some of the burden during this difficult time.

Sample - Arkansas Death Certificate Application Form

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
Deceased
First Name
Middle Name
Last Name
2 Date of Death
Month
Day
Year
Age of Deceased
Sex
3. Place Where
Death Occurred
If unknown, give
last place of
residence.
City or Town
County
State
City or Town
County
State
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.
OR
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.)
VR-8 (R 8/11)

Form Information

Fact Name Details
Office Location The Arkansas Department of Health Vital Records is located at 4815 West Markham, Little Rock, AR 72205.
Eligibility This office only records deaths that occurred in Arkansas.
Historical Records Records for deaths prior to February 1, 1914, are limited and may not be available.
Application Fee The fee for the first certified copy is $10.00, with each additional copy costing $8.00.
Payment Method Payments must be made via check or money order, payable to the Arkansas Department of Health. Cash should not be sent.
Search Fee Policy A $10.00 search fee is retained if no record is found. Only names and dates listed will be searched for this fee.
Identification Requirement A photo ID is required when submitting the application.
Processing Time Allow 4-6 weeks for processing of the application.
Ordering Methods Certificates can be ordered online, by telephone, or in person at the office.
Legal Consequences Providing false information on the application may result in fines up to $10,000 or imprisonment for up to 5 years (Arkansas Statutes 20-18-105).

Detailed Guide for Filling Out Arkansas Death Certificate Application

Filling out the Arkansas Death Certificate Application form is a straightforward process that requires careful attention to detail. Once you have completed the form, you will need to submit it along with a copy of your photo ID and the appropriate fee. Processing typically takes 4-6 weeks, so it’s advisable to plan accordingly.

  1. Begin by entering the full name of the deceased. Include the first name, middle name, and last name.
  2. Next, fill in the date of death in the format of month, day, and year.
  3. Provide the place of death, including the city or town, county, and state. If this information is unknown, indicate the last place of residence.
  4. Enter the name of the funeral home that handled the arrangements.
  5. List the address of the funeral home.
  6. Fill in the name and address of the attending certifier.
  7. If the deceased was an infant, indicate whether it was stillborn by selecting "Yes" or "No."
  8. State your relationship to the deceased.
  9. Explain your reason for requesting a copy of the certificate.
  10. Sign the application and provide your telephone number.
  11. Indicate how many copies you are requesting. The first copy costs $10.00, and each additional copy costs $8.00.
  12. Calculate the total amount of money enclosed and write it down.
  13. Ensure you include a copy of your photo ID with the application.
  14. Mail the completed application, photo ID, and payment to the address provided: Arkansas Department of Health, Vital Records, Slot 44, 4815 West Markham, Little Rock, AR 72205.

Obtain Answers on Arkansas Death Certificate Application

  1. What is the cost of obtaining a death certificate in Arkansas?

    The fee for the first certified copy of a death certificate is $10.00. Each additional certified copy requested costs $8.00. It is important to include the correct payment with your application, as the total fee must accompany your request.

  2. How do I submit my application for a death certificate?

    You can submit your application by mail. Include the completed application form, a copy of your photo ID, and the payment (check or money order made out to the Arkansas Department of Health). Send everything to:

    Arkansas Department of Health Vital Records
    Slot 44
    4815 West Markham
    Little Rock, AR 72205

  3. What if I cannot find the exact date of death?

    If you are unsure of the exact date of death, you can list all possible dates on the application. However, keep in mind that each search for a different name or date will incur an additional $10.00 non-refundable fee.

  4. How long does it take to process the application?

    Processing times can vary, but you should allow 4-6 weeks for your application to be processed. If you need the certificate sooner, consider using the walk-in option or online services.

  5. Can I apply for a death certificate online?

    Yes, you can order a death certificate online through www.vitalchek.com. You will need a credit card (Visa, MasterCard, Discover, or American Express) to pay for the service fee and certificate fee. Overnight shipping is also available for an additional fee.

  6. What identification is required to request a death certificate?

    All requests for death certificates require a copy of your photo identification. This helps to verify your identity and your relationship to the deceased.

  7. Can I obtain a death certificate in person?

    Yes, you can visit the Arkansas Department of Health office to request a certified copy of the death record in person. The office is open for walk-in requests from 8:00 A.M. to 4:00 P.M., Monday through Friday. Same-day issuance is available during these hours.

Common mistakes

Filling out the Arkansas Death Certificate Application form can be a sensitive and challenging task during an already difficult time. Mistakes can lead to delays in obtaining the necessary documentation. Here are nine common errors to avoid when completing this important form.

One frequent mistake is failing to provide all possible dates of death. The application asks for a comprehensive list of potential dates. If you only include one date, and it turns out to be incorrect, you will incur additional fees for further searches. It is essential to gather as much information as possible to ensure a smooth process.

Another common error involves incomplete names. Ensure that you list the full name of the deceased, including the first, middle, and last names. Omitting any part of the name can result in complications when searching for the record. Always double-check for accuracy.

Providing an incorrect place of death is another mistake that can hinder your application. If the exact location is unknown, you should list the last place of residence. This information is crucial for the records department to locate the correct file. Take time to verify the details before submission.

Many applicants overlook the requirement for photo identification. The application explicitly states that a copy of your ID must accompany the request. Failure to include this can lead to delays or even rejection of your application. Keep this in mind as you prepare your documents.

Another issue arises when individuals do not specify their relationship to the deceased. This detail is necessary for the application process. Clearly stating your connection helps the authorities understand your right to request the certificate and ensures that the request is processed appropriately.

Some people forget to include the correct payment amount. The application specifies that the first certified copy costs $10, with additional copies priced at $8 each. Ensure that you calculate the total correctly and include a check or money order made out to the Arkansas Department of Health. Cash is not accepted.

In addition, it is important to provide a clear reason for requesting the certificate. This information is often required for processing, and failing to include it can result in delays. Be honest and straightforward in your explanation.

Another common oversight is neglecting to sign the application. The signature is a crucial part of the request, as it verifies that you are the person making the request. Without it, your application cannot be processed.

Lastly, many applicants do not allow enough time for processing. The form indicates that requests can take 4-6 weeks to process. If you need the certificate sooner, consider using the online or telephone ordering options, which may expedite the process. Planning ahead can help avoid unnecessary stress.

By being aware of these common mistakes and taking the necessary precautions, you can ensure a smoother experience when filling out the Arkansas Death Certificate Application form. Your attention to detail will facilitate a more efficient process during this challenging time.

Documents used along the form

When applying for a death certificate in Arkansas, several additional forms and documents may be necessary to facilitate the process. Each of these documents serves a specific purpose and can help ensure that the application is processed smoothly. Below is a list of commonly required forms and documents.

  • Photo Identification: A government-issued ID is mandatory for all requests. This could be a driver's license, state ID, or passport. It verifies the identity of the requester and establishes their right to obtain the certificate.
  • Funeral Home Authorization Form: This document may be required if the funeral home is submitting the death certificate application on behalf of the family. It typically includes the funeral home’s details and confirms their role in the process.
  • Proof of Relationship: To obtain a death certificate, the requester must often provide documentation proving their relationship to the deceased. This could include a marriage certificate, birth certificate, or other legal documents that establish the connection.
  • Payment Method: A check or money order made out to the Arkansas Department of Health is required for the application fee. If ordering online or via phone, credit card information will be needed to cover the costs.

Gathering these documents ahead of time can help streamline the application process for a death certificate in Arkansas. Ensuring that all necessary paperwork is in order can reduce delays and facilitate timely access to this important record.

Similar forms

The Arkansas Death Certificate Application form shares similarities with several other vital records documents. Each document serves a unique purpose but often includes comparable information and requirements. Below are nine documents that are similar to the Arkansas Death Certificate Application form:

  • Birth Certificate Application: Like the death certificate application, this form requires personal information about the individual, such as their full name, date of birth, and place of birth. It also necessitates a valid photo ID and payment for processing.
  • Marriage License Application: This document requests personal details about both parties intending to marry. It often includes information about previous marriages and requires identification, similar to the death certificate process.
  • Divorce Certificate Application: When requesting a divorce certificate, individuals must provide personal information and details about the marriage. This application also requires identification and payment, paralleling the death certificate application.
  • Adoption Record Application: This form seeks information about the adopted individual and their adoptive parents. It typically requires identification and may involve fees, much like the death certificate application.
  • Social Security Death Benefit Claim Form: This document requests information about the deceased to process benefits. It requires personal details and proof of relationship, akin to the requirements of the death certificate application.
  • Genealogy Research Request Form: Individuals seeking family history information must provide names and dates, similar to the death certificate application. Identification may also be required to access certain records.
  • Voter Registration Application: This form requests personal information to register to vote. While its purpose differs, it similarly requires identification and accurate details about the individual.
  • Passport Application: When applying for a passport, individuals must submit personal information and identification. This form, like the death certificate application, involves a fee and processing time.
  • Property Deed Transfer Application: This document requires detailed information about the property and the parties involved in the transfer. It also necessitates identification and may involve fees, mirroring the process for obtaining a death certificate.

Understanding these similarities can help individuals navigate the various forms and requirements associated with vital records more effectively.

Dos and Don'ts

When filling out the Arkansas Death Certificate Application form, it’s essential to follow certain guidelines to ensure your application is processed smoothly. Here’s a list of things you should and shouldn’t do:

  • Do provide a clear and legible full name of the deceased, including first, middle, and last names.
  • Do include all possible dates of death and names under which the certificate may be registered.
  • Do submit a copy of your photo ID along with the application.
  • Do send the correct fee: $10.00 for the first copy and $8.00 for each additional copy.
  • Don’t send cash; use a check or money order made out to the Arkansas Department of Health.
  • Don’t forget to include your relationship to the deceased and the reason for requesting the certificate.
  • Don’t submit your application without ensuring all fields are completed accurately.
  • Don’t expect immediate processing; allow 4-6 weeks for your application to be processed.

By adhering to these guidelines, you can help ensure that your request for a death certificate is handled efficiently and without unnecessary delays.

Misconceptions

Understanding the Arkansas Death Certificate Application form can be challenging. Several misconceptions often arise regarding its requirements and procedures. Below are six common misconceptions, along with clarifications for each.

  • Only immediate family members can request a death certificate. This is not entirely accurate. While immediate family members have priority, others may also request a certificate if they can demonstrate a legitimate interest or relationship to the deceased.
  • Death records prior to 1914 are readily available. In reality, the Arkansas Department of Health only has a limited number of death records for events that occurred before February 1, 1914. Many records from this period may not be accessible.
  • There is no fee to search for a death record. This is misleading. A non-refundable fee of $10.00 is required for the search. If the record is not found, this fee will still be retained to cover search costs.
  • Cash payments are accepted for the application fee. This is incorrect. The application must be accompanied by a check or money order made out to the Arkansas Department of Health. Cash should never be sent.
  • Processing times for death certificate requests are always quick. It is important to note that processing can take 4-6 weeks. Individuals should not expect immediate results, especially during busy periods.
  • Photo identification is not necessary for online or telephone requests. This is false. Regardless of the method of request, photo identification is required to obtain a certified copy of a death certificate.

By addressing these misconceptions, individuals can better navigate the process of obtaining a death certificate in Arkansas.

Key takeaways

Filling out the Arkansas Death Certificate Application form requires attention to detail and adherence to specific guidelines. Here are key takeaways to consider:

  • Eligibility: Only deaths that occurred in Arkansas are recorded by this office. Records for deaths prior to February 1, 1914, are limited.
  • Fees: The application requires a fee of $10.00 for the first certified copy and $8.00 for each additional copy. Payment must be included with the application.
  • Identification: A copy of your photo ID is mandatory when submitting the application. This ensures that the requestor is authorized to obtain the death certificate.
  • Processing Time: Expect a processing time of 4-6 weeks for the application. Plan accordingly if you need the certificate by a specific date.
  • Submission Methods: Applications can be submitted by mail, online, or in person. Each method has its own requirements and may incur additional fees for expedited services.