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VR 61 (Rev. 8/23)
Visit nyc.gov/vitalrecords for updated processing times, order status and additional information.
(Please print clearly and ll out as much information in English as you can. Forms submitted in other languages will take longer to process.
Translations of this form are available online for reference only — please ll out the English form in English.)
Who Can Apply for a Correction?
To apply for a correction, you must be the decedent’s (deceased person’s) spouse, child, parent, sibling,
grandchild, informant listed on the death certificate, or an entitled party. You must also be 18 years or older.
If you are not listed on the death certificate as the informant, the NYC Department of Health and Mental
Hygiene (the Health Department) will notify the informant of the request to amend the certificate.
Applicant information (print clearly and use blue or black ink only):
FIRST NAME MIDDLE NAME LAST NAME
RELATIONSHIP TO THE DECEDENT
MAILING ADDRESS APARTMENT NUMBER
CITY STATE ZIP CODE
PRIMARY PHONE NUMBER ALTERNATE PHONE NUMBER EMAIL ADDRESS
Decedent information currently on the death certificate:
FIRST NAME MIDDLE NAME LAST NAME
Place of death (name of hospital/nursing home/street address):
Date of death (mm/dd/yyyy): Borough of death:
Death certificate number (if known): 1 5 6 - ___ ___ - ___ ___ ___ ___ ___ ___
What item on the death certificate
would you like to correct?
(for example, date of birth, social
security number, birthplace)
How does the item currently
appear on the death certificate?
How should the item appear?
Example: Date of birth Example: 5/5/1945 Example: 5/25/1945
Application for the Correction
of a NYC Death Certificate
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VR 61 (Rev. 8/23)
Instructions
Note: If the error was made by the facility or doctor or the funeral home within 12 months of the date of death,
you should contact the facility or doctor or the funeral home.
Use the following chart to determine which documents are needed with your application.
For all types of corrections, you must include your unexpired photo identication (ID) with your application.
Item(s) To Be Corrected Type of Certified/Original Documentation Applicant Must Submit
Decedent’s Legal Name • If the error was made by the facility or doctor within 12 months of the date of death,
then contact the facility or doctor. They can submit the correction request electronically.
• If it has been more than 12 months, a letter from the facility or doctor listed on the death
certificate is required. The letter must state that they made an error with the name.
(Medical records may also be required.)
Decedent’s
Usual Residence
Two (2) proofs of address are required: letter from a government agency; utility bill;
mortgage statement; rental or lease agreement dated within three (3) months prior to
the decedent’s date of death.
Service in the
U.S. Armed Forces
Discharge paper (DD214), discharge certificate, or original letter from Veterans Affairs
Marital/Partnership
Status or Removing/
Adding the Name of
the Surviving Spouse
Civil marriage certificate, registered domestic partnership certificate, legal separation
document, divorce decree, notification of no divorce on file from the place the decedent
was married, or death certificate of spouse if widowed
Name of Surviving
Spouse/Partner
Civil marriage certificate, registered domestic partnership certificate,
or legal separation document
Date of Birth/Age
or Birthplace
Original birth certificate of decedent
Social Security Number Original Social Security card or Social Security Administration letter showing the decedent’s
full social security number
Usual Occupation Employee ID or letter from employer showing the decedent’s name and occupation
Kind of Business
or Industry
Employee ID, letter from employer, last pay stub(s), last W-2 Form, professional license
Education Diploma, degree, letter from educational institution
Aliases or AKAs
(Also Known As)
Legal court document, marriage certificate, birth certificate or letter from funeral home
admitting error
Parents’ Information Decedent’s original birth certificate
Informant’s Information •
If removing the informant’s information, a court order from Surrogate’s Court,
New York County, is required.
• If correcting the informant’s information, a government letter or utility bill, mortgage
statement or rent/lease agreement, or letter from funeral home admitting the error
Disposition Information Original letter from cemetery/crematory on letterhead, or return to the funeral home
Funeral Home
Information
Letter from funeral home on letterhead signed by the Funeral Director
Add COVID-19 as
the Cause of Death
Complete this application and submit it with a letter from a health care provider who treated
the decedent named on the death certificate.
The letter must contain: the provider’s letterhead, signature, and license number; dates
showing when the provider started and stopped treating the decedent; a statement from the
provider that the cause of death was related to COVID-19; per FEMA’s guidance, the death
certificate must indicate the death was caused by, may have been caused by, or was likely
a result of COVID-19 or COVID-19-like symptoms — the letter may include similar phrasing;
and a statement from the provider that they reviewed the current cause of death on the
death certificate.
Mail the application, letter, and all required documents to: NYC Department of Health and
Mental Hygiene, Attention: FEMA Death Certificate Amendment Request, Corrections Unit,
125 Worth Street, Room 144, CN-4, New York, NY 10013. For more information, email
[email protected], with “FEMA burial assistance” in the subject line.
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VR 61 (Rev. 8/23)
Note: Documents are subject to verification. If the information on the documents that are submitted
is insufficient or if the information on the documents does not match, then additional documents may
be required.
If your documents are in a language other than English, you must provide an English translation. Consulates
outside the U.S. will often translate official documents for you. The NYC Health Department Office of Vital
Records accepts translations from established translation services.
How Much Does It Cost To Correct a Death Certicate?
The NYC Health Department charges a nonrefundable $40 processing fee to correct most death certificates
(see below). Each corrected certificate costs $15.
Processing fee (nonrefundable): $40
Number of corrected death certificates requested:
Multiplied by $15 for each corrected certificate equals: $
Total amount enclosed: $
Please make your check or money order payable to: NYC Department of Health and Mental Hygiene.
Cash is not accepted.
No fee applies in the following instances: the request is submitted by the facility or doctor; the request
is submitted by a funeral home, if adding missing/unknown information within 12 months of death;
miscarriage or stillbirth certificate changes; or an administrative error by the NYC Health Department.
How Do I Submit an Application?
• Complete all the information on Page 1 of this application.
• Include original/certified documents, as listed on Page 2 of this application.
• Include a copy of your unexpired photo ID, such as a current driver’s license or passport.
• Include a check or money order ($40 processing fee plus $15 for each corrected certificate). No cash.
• Sign and date the bottom of this form in blue or black ink only.
• Mail to:
NYC Department of Health and Mental Hygiene
Corrections Unit
Attention: Death Certificate Correction
125 Worth Street, Room 144, CN-4
New York, NY 10013
Sign Below
SIGNATURE OF APPLICANT DATE
Warning: Submitting a false identification is a crime and violators are subject to prosecution. It is a violation
of law to make a false, untrue or misleading statement, or forge the signature of another on this application.
Violations are a misdemeanor punishable by a fine of up to $2,000.
All forms should be filled out in English, but translated forms are available online for reference only.
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