USVI Public Records

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THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS AND STATISTICS APPLICATION FOR CERTIFIED COPY OF DEATH RECORD Do Not Complete This Application Before Reading The Instructions And Information On The Back Of This Form PART A. TYPE OF CERTIFIED COPY REQUESTED: CHECK ONE: _______Death Verification Fee $6.00 _______Death Certificate Fee $15.00 A verification is an abstract from the death A certificate is an abstract from the death record record that gives the name and date of death. that gives the name, date of death, gender, place of death, and cause of death. PART B. ELIGIBILITY: DEATH VERIFICATION Anyone may apply for a death verification. DEATH CERTIFICATE CHECK ONE: _______ I am a parent, legal guardian, or sibling of the person listed on the record. _______ I am a party entitled to receive the record due to a court order. _______ I am an attorney representing the estate of the person listed on the record. _______ I can establish that the record is needed for estate settlement, entitled benefits, or another proper purpose. PART C. DISTRICT APPLYING TO: CHECK ONE - St. Croix District St. Thomas/St. John District PART D. DEATH RECORD INFORMATION: First Name on Record Middle Name on Record Last Name on Record Date of Death – mm/dd/yy Place of Death (City and Island) Sex of Decedent: Mother’s / Parent’s Name Father’s / Parent’s Name PART E. APPLICANT INFORMATION: Applicant’s First Name Applicant’s Middle Name Applicant’s Last Name Applicant’s Mailing Address State City Zip Code Type of Photo Id Photo Id# Relationship to Person on Record Purpose for Which Record is Requested Number of Copies Amount Enclosed Money Order ID # PART F. MAIL COPY OF RECORD TO: (ONLY COMPLETE THIS SECTION IF FORWARDING ADDRESS IS DIFFERENT FROM APPLICANT’S MAILING ADDRESS) First Name Middle Name Last Name Mailing Address State City Zip Code ( )___________ Signature of Applicant Physical Address Date Telephone # Do Not Complete Below Unless In The Presence Of A Notary Public Sworn To and Subscribed Before Me This __________ Day Of _______. WITNESS My Hand And Official Seal. Day Month Year (Notary Public’s Signature) INSTRUCTIONS Please submit the following: 1. Completed, notarized applications must be mailed directly TO THE DISTRICT OFFICE WHERE THE DEATH OCCURRED. 2. Virgin Islands Department of Health Virgin Islands Department of Health St. Thomas/St. John District or St. Croix District Office of Vital Records and Statistics Office of Vital Records and Statistics 1303 Hospital Ground, Suite 10 4006 Estate Diamond, Suite 104 St. Thomas, VI 00802. St. Croix, VI 00820. 3. Photocopy of your valid picture identification document, such as your driver’s license, passport card, military identification card, permanent resident card, TWIC card, valid voter’s card, state- issued identification card, or senior citizen’s card. 4. Supporting documents are required to verify the reason for the record request. 5. If applying as a legal representative or legal guardian, a certified copy of the court/appointment document is required. 6. United States Postal Money Order of $15.00, payable to the Virgin Islands Department of Health. (NO PERSONAL CHECKS WILL BE ACCEPTED) 7. A returned stamped envelope must be included with the application and must have the return address to facilitate the return of the Death Certificate(s). The Death Certificate(s) must be returned via Certified Mail, U.S. Priority Mail, Express Mail, FedEx, DHL, or UPS. NO documents will be returned by regular first-class mail. All documents returned must be trackable, so please select the recommended postage listed above. Please consult the postal carrier for rates. Submitting an incomplete application will delay processing. 8. Submittal of an incomplete application will delay processing. 9. If a record is not found, a certified “No Record Found” letter will be issued. 10. If an application is incomplete and the applicant is unreachable by phone, a “Missing Information” letter will be issued. It is very important to provide all the required information on the application. CONTACT INFORMATION Virgin Islands Department of Health Virgin Islands Department of Health Virgin Islands Department of Health Office of Vital Records and Statistics Office of Vital Records and Statistics Office of Vital Records and Statistics St. Thomas, VI St. Croix, VI St. John, VI Tel: 340-774-9000 Cell: 340-643-6302 Tel: 340-776-6400 Ext. 4685/4681/4683/4686/4687 Tel: 340-712-0117/ 340-712-0119 Ext. 6014 Tel: 340-715-5116 or 340-715-5117 340-712-0116 or 340-712-0118