INSTRUCTIONS for REQUESTING a COPY of a DEATH CERTIFICATE

If you wish to request a copy of a death certificate, please follow the instructions below:

1. Complete the form and submit it.
2. A copy of a valid photo ID must be provided.  You may attach it in the form or mail a copy to the court at the address listed below.
3. The cost is $25 for a certified copy and $5 for each additional copy received at the same time.
4. To complete your request, please send a cashiers check or money order to:
   Cook County Probate Court
   212 N. Hutchinson Ave.
   Adel, GA 31620
5. The check should be made out to – Cook County Probate Court
6. If you did not attach a copy of photo ID with your application, please make a copy of your photo ID and include it with your check

Death Certificate Request Form

Full Name at Death *

First

Middle

Last

Date of Death *

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Place of Death *

Email *

Phone Number *

Address to mail certificate *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Number of Copies *

$25 for the first copy, $5 for each additional copy

Relationship *

Signature *

Copy of Photo ID

Click or drag a file to this area to upload.

Comment

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