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 *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Place of Death *

Email *

Phone Number *

Address to mail certificate *

Address Line 1

Address Line 2

City

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.

Phone

Submit