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This office has death certificates for the entire state since 1900. Death certificates are also available in the county Vital Records office where the death occurred. Colorado Death Certificate Request **Colorado death certificates can be requested at any Vital Records location regardless of the county in which the death occurred.** Pursuant to Colorado Revised Statutes, 1982, 25-2-118 and as defined by Colorado Board of Health Rules and Regulations, applicant must have a direct and tangible interest in the record requested. The penalties for obtaining a record under false pretenses include a fine of not more than $1,000.00, or imprisonment in the county jail for not more than one year or both such fine and imprisonment (CRS 25-2-118). o This request must be completed in full. o Enclose a copy of a current driver’s license, passport or State identification. (The complete list of primary and secondary ID’s are available online at www.colorado.gov/cdphe/vitalrecords) o Enclose appropriate fees. o Person requesting to receive death certificate must sign below. o Proof of relationship or legal interest is required (see reverse side). Daytime Phone Number Requestor Information (Please Print) Deceased Information Relationship to deceased (must submit proof of relationship) *see reverse side Reason for Request: o Parent o Spouse o Grandparent o Sibling o Child o Funeral Director o Legal Representative o Other: o Insurance o Social Security o Property o Genealogy o Other: First Middle Last Month State of birth (optional) City County State Colorado ONLY Full Name of deceased Date of death* (or range of dates) Place of death Today’s date By signing below, I have read and understand that there are penalties for obtaining a record under false pretenses. Charges: (FEES NON-REFUNDABLE) *Search fee where date of death is unknown ($1.00 per year) Standard/long death certificate (cause of death IS listed): $25.00 for one $20.00 for each additional certificate of same record ordered at same $25.00 for one $20.00 for each additional certificate of same record ordered at same Total FOR OFFICE USE ONLY PAYMENT: CASH REQUIREMENTS Apply in person: Monday-Thursday 8:00 am to 4:00 pm Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] Elbert County Public Health 75 Ute Ave / PO Box 201 Kiowa, CO 80117 **Email completed applications to [EMAIL REDACTED]** SIGN HERE Name of Person Making Request Middle Last Email: First Mailing Address City State Zip Physical Address City State Zip Alt Phone Number Legal version of death certificate (cause of death NOT listed): $12.00 PRIORITY MAIL: 2 day shipping (check, money order, cash, credit card) *Within the continental U.S. Please check your shipping method: (certificates can also be picked up in office) To pay with credit card, check here: *Credit card convenience charge varies based on total amount* *staff will call you to collect that payment via phone once the request is processed* ---PAGE BREAK--- Death certificates may issued to: Document(s) needed to prove relationship: Current spouse Must be listed on death certificate. Ex-spouse Must present proof of direct & tangible interest (i.e. Social Security record, insurance policy). Parent Must be listed on death certificate. Stepparent Marriage certificate proving relationship to a parent that is listed on death certifi cate. Grandparents/Great grandparents Birth certificate(s) proving relationship required (cannot accept baptismals, hospital records or school records, unless the customer presents a letter from the state of birth stating no record of birth was found). Siblings/Half siblings Birth certificate showing at least one same parent required (cannot accept bap tismals, hospital records or school records, unless the customer presents a letter from the state of birth stating no record of birth was found). Children/Grandchildren/Great grandchildren Birth certificate(s) showing relationship is required (cannot accept baptismals, hospital records or school records, unless the customer presents a letter from the state of birth stating no record of birth was found). Step-Children Marriage certificate & birth certificate proving relationship required. Legal representative/Paralegals Proof of client relationship required as well as proof of the client’s relationship to the registrant. Opposing counsel Certificate will be mailed to court w/ motion to seal “confidential record.” Name, address and case number of the court required. Genealogists Notarized signed release from immediate family member required as well as proof of the family member’s relationship. Certificate marked “For Genealogi cal Use Only.” In-laws/aunts/uncles/nephews/nieces/ cousins For death certificate 25 years or younger- Must present proof of direct & tan gible interest (i.e. insurance policy, personal will, etc.). For death certificates over 25 years- Must present proof of relationship (a family tree would be acceptable for this case) Death certificate marked “For Genea logical Use Only.” Probate Researchers Proof of direct & tangible interest required. Creditors Proof of direct & tangible interest required. Employer Proof of direct & tangible interest required. Beneficiaries Proof of direct & tangible interest required (i.e. letter on insurance company/ pension company letterhead that clearly states the applicant is a beneficiary or is eligible to file a claim). Insurance companies Proof of direct & tangible interest required (Insurance policy). Hospital/Nursing home/Hospice/Physician Proof of patient relationship required. Funeral Directors Must be listed on death certificate. Informant Must be listed on death certificate. Others who may demonstrate a direct and tangible interest when information is needed for determination or protection of a personal or property right Proof of direct & tangible interest required.