Vital Registrar

Office of the City Secretary

Application for Death Certificate

 

WARNING: IT IS A FELONY TO FALSIFY INFORMATION ON THIS DOCUMENT. THE PENALTY FOR KNOWINGLY MAKING A FALSE STATEMENT ON THIS FORM OR SIGNING A FORM WHICH CONTAINS A FALSE STATEMENT IS TWO TO TEN YEARS IMPRISONMENT AND A FINE UP TO $10,000. (HEALTH & SAFETY CODE, CHAPTER 195, SEC. 195.003)

 
 

DEATH RECORD INFORMATION

We can only issue a death certificate for deaths that occurred within the city limits of Temple, Texas. For death certificates where the death occurred outside of the city limits of Temple, please contact the County in which the death occurred.

 
 
 
mm/dd/yyyy
 
 
 
 

REQUESTOR INFORMATION

 
 
Phone
 
 
 
 
 
 

PERSON QUALIFIED TO REQUEST A DEATH CERTIFICATE

Who can request records?


Death certificates can only be issued to a member of the deceased immediate family, or other persons with a legal and tangible interest in the record. Legal and tangible interest must be established by providing sufficient documentation to establish the need.


For the purpose of death certificate issuance, the Texas Administrative Code defines an immediate family member as: his or her legal guardian, or the children, spouses, parents, siblings, or grandparents of the deceased.


All other applicants must provide legal documentation (such as a court order establishing guardianship, an insurance policy listing the applicant as the beneficiary, etc.) that documents a direct, tangible interest in the death certificate. If this is the case, please upload the required document with proof of ID when prompted in this application.


For full details, see Persons Qualified to Request Records.

 
 
 

IDENTIFICATION

Please attach your photo identification. Failure to upload a valid ID will result in the request being declined. (NO EXCEPTIONS)


We can only accept valid government-issued identification as follows:


current US State driver's license, federal or state issued photo ID card, valid US passport or military ID card.


Please Note: State-issued identification must be current and not expired. If you do not have a valid ID listed above, please see Acceptable Identification for a list of other proof documents you can upload.


Please Note: For identification purposes, the ID that is uploaded here must be the same name as the requestor.


In addition, please upload any other proof that may be needed in order to verify you are a qualified person to request a death certificate. Please see PERSON QUALIFIED TO RECEIVE A DEATH CERTIFICATE section above for more information.

 
Drop your files here
 

RECEIVING THE DEATH CERTIFICATE

Death Certificates can be picked up in person at our Office located inside City Hall, 2 N Main St, Temple, Texas 76701.


Office Hours are M-F, 8 am-4:30 pm.


Death Certificates can also be mailed via USPS.


All records will mail out the following business day. Pick-up orders will be ready same day if ordered before 12 pm. This office is NOT responsible for misdirected or lost mail.


Please note that only the requestor can pick up the record in person and must also be the person to whom the record is mailed to.

 
 

 

AUTHORIZATION NOTIFICATION

By typing my name below, I agree that it constitutes an electronic signature and authorizes the City of Temple to release information and / or my vital record and confirms I have completed all sections accurately and truthfully, including information verifying my identity. I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other party or agency without my expressed written consent. I understand the penalty for knowingly making false statements on this form is a third-degree felony and may be punishable with up to 2 - 10 years in prison and a fine of up to $10,000 Health and Safety Code of Texas, Chapter 195, Sec. 195.003.


I have enclosed the correct fees and understand that they are nonrefundable. I understand that an incomplete form will not be processed and will be considered closed after expiration of the 30 day notification window. I declare under penalty of perjury that the foregoing is true and correct.

 
 

Payment Information

Name on Credit Card must match the name of requestor on this application or you must upload the DLs of the credit card user, if using a a card other than your own. This service may require information verification. Any falsification of information or incorrect information will result in a denial of your application or your request.

 
 

Please Note: For identification purposes, the Credit Card that is used, must be in the same name as the requestor.

 
 
 

Powered by
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.