Application for Certified Copy of Death Applicant Must Show Proof of Identification in accordance to 410 IAC 18-4-1 and 410 IAC 18-4-2 Please Complete All Items Below Name at Time of Death * date_range access_time Date of Death * date_range access_time Sullivan County (We only issue for Sullivan County) * Your Relationship to Deceased * date_range access_time Purpose for Which this Record is to be Used * date_range access_time Applicant's Name * date_range access_time Applicant's Address * date_range access_time Applicant's Address 2 date_range access_time Applicant's City * date_range access_time Applicant's State * Please select an option Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Applicant's Zip * date_range access_time Phone * 111-111-1111 date_range access_time Number of Copies Requested (Certified Copy $12 Each) * date_range access_time Applicant's Email * date_range access_time Warning: Confidentiality and disclosure guidelines are found in IC 16-37-1-10. * Upload Proof of Identification File Uploaded Files: navigate_nextSubmit Your Session Is About To Expire Click continue to extend your session. Your Session Has Expired Close your browser or click OK to begin a new session.
