FiND A SERVICE

HOW DO I...

FIND

EMERGENCY MANAGEMENT

Learn More

McHenry County Department of Health - Health Administration

A-to-Z Topic List for MCDH

Death Record Request Form

Font Size: + -

Feedback Print

Death Certificates Purchased Online

Death certificates can be ordered for dates of death from 2010 to the present. For a death records prior to 2010 please contact the McHenry County Clerk’s office or call 815-334-4510 for more information.

Please fill out the application completely including the upload of your government-issued photo ID (i.e. Driver's License, State ID, etc.). Then submit your application.

Please correct the fields below:

Please correct the field(s) marked in red below:

Full Name of Deceased (First, Middle and Last Name):

Full Name of Deceased (First, Middle and Last Name):

Date of Death (mm/dd/yyyy):
For death records prior to 2010, please contact the County Clerk

Date of Death (mm/dd/yyyy): For death records prior to 2010, please contact the County Clerk

Place of Death (Hospital Name / Home / Other - please specify):

Place of Death (Hospital Name / Home / Other - please specify):

Requestor's Name (First and Last Name):

Requestor's Name (First and Last Name):

Relationship to Deceased:

Relationship to Deceased:

Spouse

Parent

Other

Mailing Address:

Mailing Address:

Street Number and Name:

City:

State:

Zip Code:

Phone Number:

Phone Number: ext.

Requestor's Email:

Requestor's Email:

The intended use of death certificate(s):

The intended use of death certificate(s):

Number of copies requested:

Number of copies requested:

Upload requestor's government-issued photo identification here:

Upload requestor's government-issued photo identification here:

Click button for uploading file

Clear

Maximum size allowed: 32 MB

Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

To receive a copy of your submission, please fill out your email address below and submit.
Email Address