Funeral Establishment Application for Death Record
This document is an application for obtaining certified copies of death records in Riverside County. It outlines the procedure for requesting either a Certified Authorized Copy or a Certified Informational Copy. Important information regarding fees and eligibility is also included.
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How do I fill this out?
To fill out the application, begin by gathering the necessary details related to the decedent. Carefully complete Sections A and B based on the type of copy you are requesting. Make sure to provide accurate information and double-check for any errors before submission.

How to fill out the Funeral Establishment Application for Death Record?
1
Gather all required information about the decedent.
2
Select the type of certified copy you wish to request.
3
Complete Sections A and B accordingly.
4
Sign the sworn statement if requesting a certified copy.
5
Submit the application either online, via mail, or in person.
Who needs the Funeral Establishment Application for Death Record?
1
Family members needing to establish identity for legal matters.
2
Funeral home representatives to obtain death certificates for their processes.
3
Lawyers requiring death records for estate matters.
4
Health departments needing to verify demographic information.
5
Insurance agents needing proof of death for claims.
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What are the instructions for submitting this form?
To submit this form, you can send it via email to the office at vrdeaths@rivco.org or fax it to (951) 555-5555. You can also submit in person at the Riverside County Department of Public Health, Office of Vital Records, 1234 Main St, Riverside, CA 92501. Ensure that all sections are completed accurately to avoid processing delays.
What are the important dates for this form in 2024 and 2025?
For the year 2024, applications for records from 2023 and 2024 will be accepted. Ensure to apply in a timely manner to avoid delays for your required documents. Always check for any updates on important deadlines in future years.

What is the purpose of this form?
The purpose of this form is to allow individuals to formally request certified copies of death records. It serves as a vital resource for verifying identity and handling legal matters post-death. Additionally, it aids the funeral establishment in processing necessary documentation efficiently.

Tell me about this form and its components and fields line-by-line.

- 1. Local Registration #: Unique number assigned to the death record.
- 2. FIRST NAME of Decedent: The first name of the deceased individual.
- 3. MIDDLE NAME of Decedent: The middle name of the deceased individual.
- 4. LAST NAME of Decedent: The last name of the deceased individual.
- 5. Date of Death: The date when the individual passed away.
- 6. City of Death: The city where the death occurred.
- 7. Name of Funeral Establishment: The funeral establishment handling the case.
- 8. Business Applicant's Mailing Information: Includes details about the individual requesting the record.
What happens if I fail to submit this form?
Failure to submit this form will result in the inability to obtain the requested death records.
- Delay in Records Retrieval: Not submitting on time can lead to delays in receiving death certificates.
- Inability to Process Claims: Failure to provide necessary records may hinder legal and insurance processes.
- Legal Complications: Without the proper documents, challenges may arise in managing the deceased's estate.
How do I know when to use this form?

- 1. Legal Proceedings: When involved in legal matters concerning the deceased's estate.
- 2. Insurance Claims: To provide proof of death for settling insurance claims.
- 3. Genealogy Research: For family history and ancestry tracing.
Frequently Asked Questions
What is the purpose of this application?
The application is used to request certified copies of death records in Riverside County.
Who is eligible to request a Certified Authorized Copy?
Only specific relatives or legal representatives of the decedent can request this type.
How much does it cost to obtain a death record?
Each certified copy costs $24.00.
Can I apply for this document online?
Yes, you can submit your application online through our platform.
What information do I need to provide?
You will need details such as the decedent's name, date of death, and your relationship to them.
Is there a fee if no record is found?
Yes, a search fee equal to the cost of one certificate will be retained.
What happens after I submit my application?
You will receive your requested documents via mail or will be notified for in-person pickup.
Can I edit my application after it is submitted?
No, once submitted, you cannot make changes to the application.
Is my information kept confidential?
Yes, all applications are handled in accordance with privacy regulations.
What if I need assistance filling out the application?
You can contact our office for support and guidance while filling it out.