MJ Professional Solutions, LLC

Death Certificate Access Authorization

Fill out the fields below to generate a notarization-ready authorization document. You can print or "Save as PDF" after generating.

Person Granting Authorization (Signer)

Full Legal Name *

Date of Birth *

Street Address *

City, State, ZIP *

Authorized Individual (Beneficiary)

Full Name *

Date of Birth

Street Address *

City, State, ZIP *

Relationship (if any)

Notary Area (filled at appointment)

State

County

Date Signed

Important: This authorization is intended to help demonstrate legitimate interest. It does not guarantee issuance of a death certificate. Eligibility is determined by the issuing Vital Records authority under applicable law.