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: | |||
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| 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: |
$ | ||
|
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| 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.