Arkansas Death Certificate Application Form PDF 2024

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The Arkansas Death Certificate Application Form plays a crucial role in documenting the passing of a loved one. It serves as an essential legal document that records vital information about the deceased individual and is used for various purposes, including settling estates, insurance claims, and genealogical research. In this article, we will provide you with a comprehensive guide to the Arkansas Death Certificate Application Form, outlining its importance, how to obtain it, and the information required to complete it.

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Arkansas Death Certificate Application Form PDF

Arkansas Death Certificate Application Form PDF 2023

Only Arkansas deaths are recorded in this office. There are only a limited number of death records filed in this office for deaths prior to February 1, 1914. Death records can be requested online, by telephone, by mail, or in-person. The fee is $10.00 for the first certified copy requested and $8.00 for each additional certified copy of the record. If no record is found, $10.00 will be kept to cover the search charge. Only the names and dates listed will be searched for the $10.00 fee.

How To Download Arkansas Death Certificate Application Form

Importance of the Arkansas Death Certificate

A death certificate is a legal record that officially confirms the death of an individual. It contains vital information about the deceased, such as their name, date and place of death, cause of death, and other relevant details. This document is crucial for several reasons:

  • Legal Documentation: A death certificate is often required to carry out legal processes, such as transferring property and assets, settling estates, and handling insurance claims.
  • Genealogical Research: Historians, genealogists, and individuals researching their family histories often rely on death certificates to trace their ancestry and family connections.
  • Public Health and Statistics: Government agencies use death certificates to compile vital statistics on causes of death, which helps in public health planning and research.
  • Closure: For family members and loved ones, having an official death certificate provides a sense of closure and helps them navigate the necessary administrative procedures.

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Obtaining an Arkansas Death Certificate Application Form

To obtain an Arkansas Death Certificate Application Form, there are a few different methods you can use:

  • In-Person: You can visit the Arkansas Department of Health’s Vital Records office in person to request a death certificate application form. The address and office hours can be found on the official website of the Arkansas Department of Health.
  • Online: In some cases, you may be able to download the application form directly from the Arkansas Department of Health’s website. However, be sure to check the website for the most up-to-date information and instructions on how to access the form.
  • By Mail: You can also request a death certificate application form by sending a written request, along with a self-addressed stamped envelope and any required fees, to the Vital Records office.

Information Required to Complete the Arkansas Death Certificate

When filling out the Arkansas Death Certificate Application Form, you will need to provide detailed information about the deceased individual. The following are the key pieces of information typically required:

  • Decedent’s Information:
    • Full legal name
    • Date of birth
    • Place of birth
    • Social Security number (if available)
    • Date of death
    • Place of death
    • Marital status
    • Spouse’s name (if applicable)
    • Father’s name
    • Mother’s maiden name
  • Cause of Death: You will need to provide information about the cause of death, including any contributing factors and the attending physician’s name.
  • Informant’s Information: The informant is the person providing the information for the death certificate. You will need to provide their name, relationship to the deceased, address, and contact information.
  • Requester’s Information: If you are not the informant but are requesting the death certificate on behalf of the family or estate, you will need to provide your information as well.
  • Signature: The application form may require the signature of the informant and the requester.
  • Fees: Be prepared to pay a fee for each copy of the death certificate requested. The fee amount and accepted payment methods can vary, so check the official website or contact the Vital Records office for current information.

Arkansas Death Certificate Application Form PDF 2023

Certificates may be ordered by the following methods: (All requests require identity verification)

Internet: ar.gov/vitalrecords A $5.00 non-refundable processing fee and a $1.85 identification verification fee will be charged in addition to any expedited shipping options selected. Fees can be paid by debit or credit card (VISA, Mastercard, Discover, or American Express). Requests typically take 7 – 14 business days from the date your order is approved plus shipping time.

Telephone: Toll free (866) 209-9482. The service fee and the certificate fee are charged to your debit or credit card (Visa, Master Card, Discover or American Express). Overnight shipping is available for an additional fee.

Mail: Mail this application, a copy of your photo ID, and your check or money order to:

Arkansas Department of Health
Vital Records Section-Slot 44
4815 West Markham Street
Little Rock, AR 72205

The fee must be sent along with the application. Make the check or money order payable to the Arkansas Department of Health. DO NOT SEND CASH. Please allow 7-14 days for processing.

Walk-in: Bring your photo ID and this completed application to the office. Orders are accepted for same day issuance from 8:00 A.M. until 4:00 P.M. Monday through Friday. The office is located at 4815 West Markham St. Little Rock, AR 72205. Please order family history and
genealogy by mail or online.

Any person who willfully and knowingly makes any false statement in an application for a certified copy of a vital record filed in this state is subject to a fine of not more than ten thousand dollars ($10,000) or imprisoned not more than five (5) years, or both (Arkansas Statutes 20-18-105.)

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Order Arkansas Death Records

Arkansas Death Certificate Application Form PDF 2023 : ADH is pleased to offer vital records services in all local health units. Click here to see your Local Public Health Unit.

How can I obtain a death certificate?

Eligible individuals (click here to see the list of eligible individuals) may order a death certificate by any of the following methods:

  • Online: You may order a copy of a death record in minutes through Vital Records

Multiple expedited shipping options are available through this service. Pay the service fee, certificate fee, and charges for any expedited shipping options by debit or credit card (Visa, Mastercard, Discover, or American Express). Requests typically take 7-14 business days from the date your order is approved plus additional shipping time.

  • By Mail: You may order a certified copy of the death record by mailing in a completed (available here or from your local health unit, a check or money order made out to Arkansas Department of Health (no cash or temporary checks), and a copy or copies of acceptable ID to:

Arkansas Department of Health
Vital Records, Slot 44
4815 West Markham Street
Little Rock, AR 72205

Please allow 10-14 days for processing, in addition to mail delivery time.

  • Walk-in: You may order a certified copy of the death record by coming into the Arkansas Department of Health’s vital records office. The office is located at 4815 West Markham St. Little Rock, AR 72205, across the street from War Memorial Stadium, and is open Monday through Friday, 8:00 A.M. until 4:30 P.M. The office is closed on state holidays. Most certificate requests can be fulfilled the same day for customers arriving by 4:00 P.M., provided they are eligible to receive the certificate requested and have all the required information, including acceptable ID (see above).  However, same day service is not guaranteed for non-routine requests such as certificate corrections, court orders, paternity affidavits, and genealogical requests prior to 1935. Customers who arrive in the office after 4:00 P.M. may pick up their request the following day or may ask that it be mailed. Walk-in payment options are cash, credit or debit cards, or a check or money order made out to Arkansas Department of Health (no temporary checks are permitted).
  • Telephone: You may order a copy of the death record via telephone toll-free at (866) 209-9482. Multiple expedited shipping options are available through this service. Payment of service fee, certificate fee, and charges for any expedited shipping options may be made by debit or credit card (Visa, Mastercard, Discover, or American Express). 

Who should I contact with additional questions about ordering a death certificate?

If you have questions on registering, amending, or obtaining copies of vital records, please contact the Arkansas Department of Health Vital Records Office at: [email protected]. Office hours are Monday through Friday, 8:00am to 4:30pm, with the exception of state holidays. If you are having technical difficulties, contact the Information Network of Arkansas Help Center online.

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How can I check on the status of my vital record order?

To obtain the status of an order you have submitted, use the “Check Order Status” service. Simply enter your confirmation number to view your status.

Why was i sent this cause of death query form?

Did you read both sides of the query form? If you are still unsure what to do, contact Marilea Brock at 501- 661-2497 or at [email protected].

I don’t know the cause of death. What should I do?

See Unknown and Uncertain Causes of Death.

Do I need to complete a death certificate at the time of death?

No! State law gives all certifiers two work days in which to complete the cause of death section and sign the death certificate. No one can require the certifier to complete and sign the death certificate at the time of death or at the death scene. A death certificate is NOT required prior to removing the body from the death scene.

The funeral home may remove the body if death has been pronounced and the physician or appropriate official (county coroner or state medical examiner) has been notified and permits removal of the body. In fact, many funeral homes complete Items 1-17e of the certificate before giving it to the certifier to complete and sign the cause of death section. It might be convenient and time-saving to complete the cause of death and sign the certificate at the time of death.

However, this often results in inadequate reporting of the cause of death. The most important medical information on the death certificate is to identify the underlying cause of death. In many cases, the underlying cause of death cannot be determined without reviewing the complete medical history or record and/or contacting the deceased’s regular physician.

How much do death Arkansas certificates cost? 

The cost of a death record is $10.00 for the first copy and $8.00 for each additional copy of the same record that is ordered at the same time. If you choose to order online through Vital Records, a $5.00 standard processing fee and a $1.85 non-refundable identity verification fee will be charged in addition to the cost of any expedited shipping options you select. If no record is found or no copy is made, state law requires that we keep $10.00 for a search fee. The processing fee for online orders is also non-refundable. However, you will receive a refund of any amount you paid apart from these fees.

Is there a list of conditions that can be reported?

No. Such a list would be very long! Also, such a list would imply that terms not on the list should not be used on the death certificate. The National Center for Health Statistics instructs states NOT to use “pick lists” of allowable medical terms. There are, however, lists of conditions that do not adequately identify the underlying cause of death. These are not forbidden terms, just terms that require further explanation. See also TERMS THAT DON’T IDENTIFY UNDERLYING CAUSE OF DEATH.

You have sent me a question form. Do I need to submit a new certificate?

No. We’ve already accepted and filed a certificate for that death. Add or correct information on the same query form you were sent.

Does the announcer also have to complete the death certificate?

No. The person who pronounces death may not know enough about the deceased’s medical history to adequately identify the causes of death, especially the underlying cause of death. One person may pronounce death so the body can be removed, and then the cause of death may be completed and signed later by the deceased’s regular physician or another person who is familiar with the deceased’s medical history.

In 2008, the time pronounced dead and the Pronouncer’s name and title have been added to the certificate. Also, note that Item 26a, Certifier, now differentiates between “certifying physician” and “pronouncing & certifying physician.” If the physician who signs 26a did not also pronounce death, he or she should check the “certifying physician” box. If the same physician pronounced death and signed 26a, he or she should check the “pronouncing & certifying physician” box.

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