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Free Nyc Health Vr 66 Form

The Nyc Health VR 66 form is an application used to request a death certificate in New York City. This form is essential for individuals seeking to obtain vital records for various legal and personal purposes. Understanding the requirements and process associated with this form is crucial for timely and accurate submissions.

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The NYC Health VR 66 form serves as a crucial tool for individuals seeking to obtain a death certificate in New York City. This form is not just a piece of paper; it is a gateway to accessing important legal documentation needed for various purposes, such as settling estates, claiming benefits, or fulfilling personal needs. Applicants must provide essential information, including the deceased's name, date of death, and place of death, as well as their own relationship to the deceased. The form also requires details about the deceased's family, including the names of spouses or domestic partners, which can help verify eligibility for obtaining the certificate. Additionally, it outlines the fees associated with the request, which vary based on the number of copies needed. Importantly, the form emphasizes the necessity of providing valid identification and, in some cases, documentation to prove the applicant's right to the certificate. This includes options for expedited service for urgent needs, ensuring that individuals can receive the documentation they require in a timely manner. Understanding the requirements and processes outlined in the VR 66 form can significantly ease the burden during a difficult time, allowing families to focus on their healing while navigating the administrative aspects of loss.

Similar forms

Death Certificate Application (Form VS-100): Similar to the NYC Health VR 66 form, this application is used to request a certified copy of a death certificate in New York State. Both forms require information about the deceased, including their name, date of death, and relationship to the applicant.
Birth Certificate Application (Form VS-100): This form is used to obtain a certified copy of a birth certificate. Like the VR 66, it asks for personal details and the applicant's relationship to the individual whose certificate is being requested.
Marriage Certificate Application: This document requests a certified copy of a marriage certificate. It shares similarities with the VR 66 form in that it requires identification and proof of relationship to the individuals named on the certificate.
Divorce Certificate Application: Similar to the VR 66 form, this application allows individuals to request a certified copy of a divorce decree. Both forms require personal information and proof of relationship.
Vital Records Request Form: This general form is used to request various vital records, including birth, death, and marriage certificates. It mirrors the VR 66 in its requirement for identification and relationship verification.
Affidavit for Disposition of Remains: This document is used to authorize the disposition of a deceased person's remains. It is similar to the VR 66 as it requires information about the deceased and the relationship of the signer to the deceased.
Certificate of Death (Form 206): This form is used to report a death to the state. It is similar to the VR 66 in that it collects essential information about the deceased and their death.
Application for a Certified Copy of a Death Record (Form 100): This application is used specifically for requesting a death record. It requires similar information to the VR 66, such as the deceased's details and the applicant's relationship.
Authorization to Release Medical Records: This document allows individuals to obtain medical records after a person's death. Like the VR 66, it requires proof of relationship to the deceased.

Form Preview

http://www.nyccfb.info/public/VRC/registeringToVote.aspx?sm=public_rtv

Office of Vital Records

125 Worth Street, CN-4, Room 133

New York, N.Y. 10013-4090

SEE INSTRUCTIONS AND

APPLICABLE FEES BELOW AND

ON BACK

DEATH CERTIFICATE APPLICATION

(Please Print Clearly)

1. LAST NAME AT TIME OF DEATH

2. FIRST NAME

3. ☐ FEMALE

☐ MALE

4. DATE OF DEATH

5. IF YOU DON’T KNOW THE EXACT DATE OF DEATH

BEGIN

END

YYYY

6. PLACE OF DEATH

7. BOROUGH

8. AGE

9. HOW MANY COPIES

10. DO YOU NEED A LETTER OF

MAN ☐ BRONX ☐ BKLYN ☐ QUEENS ☐ SI ☐

DO YOU NEED?

EXEMPLIFICATION ☐ YES ☐ NO

11. SPOUSE OR DOMESTIC PARTNER’S NAME

12. LAST KNOWN ADDRESS

13. OCCUPATION OF DECEASED

14. FATHER/PARENT’S NAME

/ʼ

16. SOCIAL SECURITY NUMBER

17. CERTIFICATE NUMBER (if known)

18. WHY DO YOU NEED THIS CERTIFICATE?

19. WHAT IS YOUR RELATIONSHIP TO DECEASED?

PLEASE PRINT YOUR MAILING AND CONTACT INFORMATION CLEARLY BELOW

NAME

DAYTIME

PHONE

NUMBER

Area Code

Telephone Number

E-MAIL

ADDRESS

20. DO YOU NEED THE CAUSE OF DEATH? ☐ YES

☐ NO

21. FEES

You may only obtain cause of death if your relationship to the deceased is

$15 per copy x _________ copies

$ _________

listed below:

Cost of certified copy includes a two consecutive year search

Please check the appropriate box

☐ Spouse or Domestic Partner ☐ Parent or Child ☐ Sibling

$3 for each extra year searched x _______ years

$ _________

☐ Grandparent ☐ Grandchild

Total Amount Enclosed: $ _________

☐ Person in control of disposition on death certificate

IF RECORD IS NOT ON FILE, A CERTIFIED “NOT FOUND STATEMENT” WILL BE ISSUED.

APPLICATIONS SUBMITTED BY MAIL MUST

NOTARY PUBLIC SEAL

22. CUSTOMER SIGNATURE. IF BY MAIL MUST BE NOTARIZED

BE NOTARIZED

By my signature below, I state I am the person whom I represent myself to be

herein. I affirm the information within this form is complete and accurate. In

STATE OF

addition, I acknowledge that misstating my identity or assuming the identity of

another person including forging a signature may subject me to a misdemeanor

COUNTY OF

and violators may also be subject to a fine of up to $2,000.

SUBSCRIBED AND SWORN BEFORE ME:

THIS ______ DAY OF _______________ , 20 ____

Signature (required)

Date

NOTARY PUBLIC SIGNATURE

Credit cards are not accepted for mail-in orders. Please make your check or money order payable to the NYC Department of Health and Mental Hygiene. If from a foreign country, send an international money order or check drawn on a U.S. bank. Cash is not accepted by mail or in person.

ORDER DEATH CERTIFICATES QUICKLY AND SECURELY AT WWW.NYC.GOV/VITALRECORDS

VR 66 (Rev. 01/15)

IMPORTANT DEATH CERTIFICATE INFORMATION

‚You can obtain a death certificate if you are the spouse, domestic partner, parent, child, sibling, grandparent or grandchild of the decedent, or if you establish your right to obtain this document (see documentation requirements below).

‚All death certificates are mailed, usually within 2-4 weeks. If there is an urgent need, and documentation is provided, you can request expedited services and you will be called to pick up the certificate in 5-7 business days.

‚Falsifying information, including forging a signature, to obtain a death certificate is a misdemeanor and violators may also be subject to a fine of up to $2,000 per violation.

‚Submitting fraudulent identification is a crime and violators are subject to prosecution.

‚Please see below for identification requirements, fees and other important information.

‚ID requirements are subject to change.

3 WAYS TO ORDER A NEW YORK CITY DEATH CERTIFICATE

●Online: Visit www.nyc.gov/vitalrecords to order using a credit card, debit card or electronic check. “Only spouses, domestic partners, parent, siblings, grandparent, grandchild, or person in charge of the disposition (informant) may submit orders online”

●Walk-In: Go to 125 Worth Street in Lower Manhattan and use the Lafayette Street (handicapped accessible) or Centre Street entrances. We are open Monday through Friday 9:00AM – 3:30PM. Lines are shortest

in the morning.

●By Mail: Applications submitted by mail must be signed in the presence of a Notary Public. Mail your application to 125 Worth Street, CN-4, New York, NY 10013. Be sure to include a self-addressed, stamped, envelope with your check or money order. You also will need to provide a photocopy of the required identification and any necessary documentation (see below).

Identification (ID) Requirements including the deceased’s spouse, domestic partner, parent, sibling, grandparent, grandchild, or person in charge of the disposition (informant)

We accept any of the following, IF it includes your photo, your signature and is unexpired:

●Driver’s License or Non-driver’s ID Card

●IDNYC Municipal ID

●Passport

●Government ID

●Employment ID with pay stub

If you don’t have any of the above, we also accept:

●Inmate photo ID with release papers

●Two different documents as indicated below if they show your name and address and are dated within the past 60 days, we will MAIL the certificate

m Utility or telephone bills

m Official government mail that you have received

If you do not have the items required above, you may email nycdohvr@health.nyc.gov for additional information and options.

Documentation Requirements for applicants NOT related to the deceased

If you are not related to the deceased, you need to establish your right to obtain a death certificate. You may obtain a death certificate if you are the legal representative of the estate, a party with a property right to protect or assert, or if you can specify another judicial or other proper purpose.

●Insurance Policy

●Will

●Bank Book or statement

●Property Deed

●Other document showing entitlement

If you are unable to provide the required documents, ask us for help by calling 311 or 1-212-NEW-YORK if you are outside of New York City.

VR 66 (Rev. 01/15)

Common mistakes

Filling out the NYC Health VR 66 form can be a straightforward process, but there are common mistakes that applicants often make. One significant error is failing to provide accurate information regarding the deceased's name. The form requires the last name at the time of death and the first name. If either of these is incorrect or misspelled, it can lead to delays or complications in processing the application.

Another frequent mistake is neglecting to include the correct date of death. The form asks for the exact date, but if the applicant is unsure, they must indicate the search period clearly. Omitting this information can cause the application to be rejected or delayed, as the vital records office may need to conduct additional searches.

Additionally, applicants often overlook the necessity of notarization when submitting the form by mail. The signature must be notarized to validate the application. Failure to have the signature notarized will result in the application being deemed incomplete, which can prolong the time it takes to receive the death certificate.

Lastly, many individuals forget to include the appropriate payment for the requested copies. The form specifies the fee structure, but applicants sometimes miscalculate the total amount or fail to include a check or money order. This oversight can halt the processing of the application until the payment issue is resolved, leading to further delays.

More About Nyc Health Vr 66

What is the NYC Health VR 66 form used for?
The NYC Health VR 66 form is an application for obtaining a death certificate in New York City. It allows individuals who are legally entitled to request a certified copy of a death certificate for various purposes, such as settling an estate, claiming insurance benefits, or fulfilling legal requirements.
Who is eligible to request a death certificate?
Eligibility to request a death certificate is limited to certain individuals. You can apply if you are:
- The spouse or domestic partner of the deceased
- A parent or child of the deceased
- A sibling, grandparent, or grandchild of the deceased
- Someone in charge of the disposition of the deceased's remains
If you are not related to the deceased, you must provide documentation that establishes your right to obtain the certificate, such as a legal representative of the estate or a document showing a property right.
How can I submit my application for a death certificate?
You have three options for submitting your application:
- Online: Visit www.nyc.gov/vitalrecords to order using a credit or debit card.
- Walk-In: Go to the Office of Vital Records at 125 Worth Street, Lower Manhattan. The office is open Monday through Friday from 9:00 AM to 3:30 PM.
- By Mail: Complete the form, notarize it, and mail it to 125 Worth Street, CN-4, New York, NY 10013. Include a self-addressed, stamped envelope and a photocopy of your identification.
What are the fees associated with obtaining a death certificate?
The fee for a certified copy of a death certificate is $15 for the first copy. If you need additional copies, they cost $15 each as well. If you require a search for records beyond two years, there is an additional fee of $3 for each extra year searched. Payment must be made via check or money order made out to the NYC Department of Health and Mental Hygiene. Please note that cash and credit cards are not accepted for mail-in orders.

Misconceptions

Understanding the NYC Health VR 66 form can be tricky. Here are six common misconceptions:

Only family members can apply for a death certificate. While immediate family members have priority, others may obtain a certificate if they can prove a legitimate interest, such as being a legal representative of the estate.
You can pay with a credit card by mail. This is incorrect. Credit cards are only accepted for online orders. For mail applications, payment must be made via check or money order.
All applications are processed immediately. In reality, standard processing takes 2-4 weeks. If urgent, expedited services are available but require proper documentation.
You don’t need to provide identification if you are related to the deceased. Identification is still necessary, even for family members. This helps verify your relationship and identity.
You can obtain the cause of death without restrictions. Access to the cause of death is limited to specific family members. Make sure to check your eligibility before applying.
Submitting the form online is the only way to apply. There are three ways to apply: online, in person, or by mail. Choose the method that works best for you.

Clarifying these misconceptions can help streamline the process and ensure you have the correct information when applying for a death certificate.

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Key takeaways

1. Ensure you fill out the NYC Health VR 66 form clearly and accurately. Use block letters to avoid any confusion.

2. You can only apply for a death certificate if you are a close relative or have established rights to obtain it. This includes spouses, domestic partners, parents, children, siblings, grandparents, and grandchildren.

3. If you are not related to the deceased, you must provide documentation proving your right to request the certificate, such as a will or insurance policy.

4. Be aware of the fees associated with obtaining copies of the death certificate. The standard fee is $15 per copy, with additional charges for extra years searched.

5. You have three options for submitting your application: online, in person, or by mail. Choose the method that best suits your needs.

6. If applying by mail, your application must be notarized. Include a self-addressed, stamped envelope for the return of your certificate.

7. Expect to receive the death certificate by mail within 2-4 weeks. If you need it urgently, you can request expedited service for quicker processing.

8. Remember that falsifying information on the application is a serious offense. Violators can face fines and criminal charges.

9. Keep your identification ready. Acceptable forms include a driver’s license, passport, or government-issued ID. Ensure these documents are current and include your photo and signature.

Nyc Health Vr 66: Usage Guide

Completing the NYC Health VR 66 form is essential for obtaining a death certificate. This document is necessary for various legal and personal matters. Follow these steps carefully to ensure that your application is processed without delays.

Start by clearly printing your last name at the time of death in the first field.
In the next field, provide the first name of the deceased.
Select the gender of the deceased by checking the appropriate box: FEMALE or MALE.
Enter the date of death in the format MM/DD/YYYY.
If the exact date of death is unknown, fill in the begin and end search dates.
Specify the place of death in the designated field.
Indicate the borough where the death occurred by checking one of the options: Bronx, Brooklyn, Queens, or Staten Island.
Provide the age of the deceased at the time of death.
Indicate how many copies of the death certificate you need.
Check the box if you require a letter of exemplification.
Enter the spouse or domestic partner’s name.
Provide the last known address of the deceased.
Fill in the occupation of the deceased.
Input the father/parent’s name.
Enter the social security number of the deceased.
If known, provide the certificate number.
State the reason you need this certificate.
Describe your relationship to the deceased.
Clearly print your mailing and contact information below.
Indicate if you need the cause of death by checking yes or no.
Calculate the fees based on the number of copies and years searched, and write the total amount enclosed.
Sign the form, ensuring it is notarized if submitted by mail.

After completing the form, review all entries for accuracy. Ensure that the application is signed and notarized if necessary. Once finalized, submit the form along with the required payment and identification documents. The processing time typically ranges from 2-4 weeks, but expedited services may be available if needed urgently.

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