ON-LINE DEATH CERTIFICATE ORDER FORM

Death certificates needed for the following as proof of death:

Social Security
Life insurance (each company)
Banking and checking accounts (each bank)
Probate of will
Federal and state tax returns (each return)
Real estate
Pension
Motor vehicle
Loans
Veterans Administration (free copy)
Stocks & Bonds
Charge accounts

Megaro Memorial Home obtains the first set of certified copies at the Belleville Board of Health at $10.00 per copy. Photocopies are rarely accepted.

At any future date, additional copies must be obtained at the Board of Health in the town the death occurred at the cost prescribed by that municipality. You will need to provide a photo ID and proof of relationship to the deceased. Ideally, whoever is listed as the informant on the original is the best person to apply.

Out of state death certificates are obtained by the funeral director contracted to handle the initial call for service. Once a copy is submitted, it is seldom returned. Therefore we suggest our families order a few extras as a precaution if and when a need arises.

If an autopsy is performed and the results are pending, it usually takes 6-8 weeks for the cause to be determined. The final results are available only to the family of the deceased through the medical examiner's office.

To order copies of a Death Certificate, please fill out and submit the following on-line form.

Please complete (as much as possible) the information on the form and select 'Submit Request' at the end to send the request to us.

If you have any questions whatsoever, please contact Megaro Memorial Home at: (973)759-7600

NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

Deceased Vital Statistics for Death Certificate:

* Deceased First Name:

* Deceased Last Name:

Street Address:

City/Town:

County:

State:

Zip Code:

Date of Birth:

Place of Birth:

City:

State:

Country:

Date of Death:

Place of Death - Location:

If other location, please indicate:

Place of Death - Name:

Place of Death - Street:

Place of Death - City:

Place of Death - State

Place of Death - County:

Full Name of Surviving Spouse:

Death Certificate Quantity Requested:

Cost: $10.00 each

Informant/Person In Charge Information:
* First Name:
* Last Name:
Relationship To Deceased:
* Email Address:
Telephone Number:

Other Information & Instructions
Please list any other information or instructions you would like us to have:

		503 Union Avenue • Belleville, NJ 07109-2215 973-759-7600 • Fax: 973-759-8117 Email:
Pasquale A. Megaro, Jr., Manager N.J. Lic. No. 3408

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ON-LINE DEATH CERTIFICATE ORDER FORM

Deceased Vital Statistics for Death Certificate:

Informant/Person In Charge Information:

Other Information & Instructions