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Death certificate fee worksheet
Print this page and mail or fax it with your completed application(s).
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| Print your name as it appears on your application: |
 |
| How many |
Item |
Fee for each |
Total |
|
First certificate for each death record ordered |
$13 |
$ |
|
Additional certificates for same record |
$6 |
$ |
|
Optional - An Expedite fee is a per-record
fee that will place your request ahead of other requests. An Expedite fee does NOT
include Federal Express or other special mailing fees. |
$20 |
$ |
|
Optional - Federal Express Mail Service is
$16 for most deliveries. Higher rates apply to Saturday or international
service and to deliveries to Alaska and Hawaii. |
$16
(per order only) |
$ |
| |
VitalChek Network user fee - mandatory if
ordered with a credit card (Master Card, VISA, American Express, or Discover
Card). |
$6
(per order only) |
$ |
| Total amount included: |
$ |
|
| Credit card users: |
| Card number: |
| Expiration date: |
Make your check or money order payable to the Minnesota Department of Health.
Checks returned for nonpayment will be charged a $30 fee according to Minnesota
Statutes, section 604.113, subdivision 2, and civil penalties may be imposed
for nonpayment.
Mail the completed application form, death certificate fee worksheet,
and payment to:
Minnesota Department of Health
Attention: Office of the State Registrar
P.O. Box 64499
St. Paul, Minnesota 55164-0882
OR
Fax the completed form, death certificate fee worksheet, credit card
(Master Card, VISA,and Discover Card) number and expiration
date to 651-201-5740.
If you have questions, please e-mail health.osr1@state.mn.us
or call 651-201-5970.
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