Application for Correction of Certificate of Death
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application for Correction
of Certificate of Death
Deceased District Number
Date of Death Register Number
Place of Death State Number
See Reverse Side for Instructions
I,
of
(name of applicant)
(address of applicant)
request that the following information amend the certificate of death identified above:
ITEM IN ER~\OR
(or omitted)
AS IT APPEARS
AS IT SHOULD BE
Documentary evidence submitted herewith in support of this application includes:
Explain reason for error or omission:
Under the penalties of pe~ury, I hereby affirm that the statements made herein are true and correct to the best of my knowledge.
Signature of Applicant
Relationship to Deceased
Date
The above information has been added to the local record of death on file in this office.
Signature of Registrar
District Number
Date
DOH-299 (6/99) Page 1 of 2
(OVER)
Instructions for Completing Correction Form
Purpose
This form may be used to correct information entered in error or to add information omitted at the
time the original death certificate was filed. Any other change or alteration of information on a
death certificate cannot be made without a court order
Signature
This form should be completed and signed by:
1. The physician who signed the original death certificate.
or
2. The individual who furnished the information for the original certificate.
Documentary 1.
Evidence
Documentary evidence IS NOT REQUIRED for the following changes:
a. ADDITION OF INFORMATION which was not available at the time the death certificate was
originally filed.
b. MINOR CHANGES IN SPELLING OF GIVEN NAME OR SURNAME of deceased or parents
(such as Smith to Smyth, Myer to Meyer, Bob to Robert, Jack to John, etc.). Any significant
change in name or spelling of name must be documented, per instructions below.
c. A CHANGE OF ONE YEAR OR LESS IN DATE OF BIRTH OF DECEASED.
Documentation is required for a change of more than one year.
2. Documentary evidence IS REQUIRED for all other corrections and must be submitted with
this form.
a. DOCUMENTS NORMALLY ACCEPTED AS PROOF FOR A CORRECTION ARE: birth
certificate of deceased, marriage record, church or synagogue record, physician's office
record, census record. A detailed listing of documents is enclosed, or may be obtained
from the New York State Department of Health.
b. THE DOCUMENT MUST INCLUDE SUFFICIENT INFORMATION TO IDENTIFY THE
DEATH CERTIFICATE TO BE CORRECTED.
c. THE DOCUMENT MUST VERIFY THE INFORMATION TO BE CORRECTED. (If the age
of the deceased is incorrect, the document must show the correct date of birth; if the
birthplace, the document must show the correct place of birth, etc.)
d. A DOCUMENT WHICH HAS BEEN ALTERED CANNOT BE ACCEPTED as proof for a
correction.
Return to:
Correction Unit
Vital Records Section
P.O. Box 2602
Albany, NY 12220-2602
or
Registrar of Vital Statistics
(for your local area)
Instructions to Registrar: If this form is returned to you satisfactorily completed, with appropriate documentary evidence (if
required), you may enter the correction on the local record and issue copies immediately. Sign the bottom of the form and send it,
with the documentary evidence, to the State Health Department so the original certificate may also be corrected. If you wish to
have the correction form and evidence reviewed before you amend the local record, do not sign the bottom of the form but send it
directly to the State Health Department. In this case, we will review the form and notify you as to whether or not the original
certificate and your local record should be amended.
DOH-299 (6/99) Page 2 of 2
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Listing of Supporting Documents Which
May be Submitted With the Application for
Correction of Certificate of Death (DOH-299).
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1. The document submitted must include sufficient information to identify the death certificate to be corrected.
2. The document must verify the information to be corrected. If the spelling of the name is incorrect, the document must show correct
spelling; if age is incorrect, the document must show correct date of birth, etc.
3. A document which has been altered cannot be accepted as proof for a correction.
4. Insurance policies and applications for insurance ARE NOT ACCEPTABLE as evidence to correct age and date of birth of
deceased.
5. Certified document is required, photocopy or other reproduction IS NOT ACCEPTABLE unless certified by the custodian of the
original record.
FOR CORRECTING: Name of Deceased, Date of Birth, Place of Birth or Names of Parents of Deceased:
1. Birth Certificate of Deceased: Send certified copy. If birth occurred after 1880 in New York State (outside of New York City),
furnish name, place and date of birth and names of parents so we may locate the certificate in our files.
2. Baptismal Certificate or other Church or Synagogue Record: Record must bear the raised seal of the church or synagogue or
must be made on stationery of church or synagogue and be signed by present custodian of records.
3. Armed Forces Discharge: Send copy of official papers.
4. Naturalization Papers or Alien Registration Card: Send original papers by registered mail. It is illegal to make copies of these
documents. After review, original papers will be returned by registered mail.
5. Hospital Record or Physician's Office Record of Death: Send certified copy, signed by physician or person having custody of
hospital records.
6. Federal Census Record: A Federal Census was taken on the following dates: June 1, 1900; April 15, 1910; January 1, 1920;
April 1, 1930, 1940, 1950, 1960, 1970, 1980 and 1990. A record may be obtained by writing to the U.S. Census Bureau,
Pittsburgh, Kansas, giving full name of person whose certificate is to be corrected, names of parents and exact address at which
he/she lived on the dates when a census was taken. Because of the heavy demand, it may take a month or longer to receive the
census record. There is a fee of $25.00 for this service. The fee must be in the form of a money order or check, payable to the
Census, Department of Commerce. An application form is enclosed for your convenience.
7. Early School Record: Must be made on the stationery of the school (report cards and diplomas are not acceptable), must show the
name of the individual, date of birth (or date document was made and age at that time) and names of parents.
Marital Status of Deceased:
8. Marriage Record of Deceased: Send certificate of marriage record, license and application (full record of marriage is required). If
license was issued in New York State (outside of New York City), simply furnish the names of both parties (including the maiden
name of wife), place and date of marriage and place of issuance of license.
9. Affidavit From Surviving Spouse: Sworn statement, signed in the presence of a notary public, indicating that he/she is the legal
surviving spouse, setting forth place and date of marriage and stating that the marriage was never legally dissolved by divorce or
annulment.
10. Affidavit of Informant: Sworn statement, signed in the presence of a notary public. by person who furnished funeral director with
information for death record; indicating the reason why incorrect information was furnished at the time the death certificate was
prepared and stating the true marital status of the deceased at the time of death along with the full name of the legal surviving
spouse.
Date of Death or Time of Death:
11. Hospital Record of Deceased: Statement must show admission date and be signed by the custodian of hospital records.
12. Physician's Office Record: Statement must be based on office records and must be signed by attending physician or coroner or
medical examiner.
Usual Occupation:
13. Employment Record: Record must show dates of employment and be signed by officer having custody of employment records for
company.
Residence of Deceased:
14. Voter Registration Card: This record may be obtained from the County Board of Elections of the county of residence of deceased.
Social Security Number of Deceased:
15. Social Security Identification Card or verification on letterhead stationery from the Social Security Administration.
Send Application to Correct a Death Certificate and Appropriate Supporting Documents to:
Correction Unit
Vital Records Section
P.o. Box 2602
Albany, NY 12220-2602
OR
Local Registrar of Vital Records
(where the death occurred)
DOH-299(i) (6/98)