Application For Death Record (Los Angeles) {76A639D}

76A639D - APPLICATION FOR DEATH RECORD. Pursuant to Health and Safety Code 103526, the following individuals are entitled to an AUTHORIZED certified copy of a death record: • A member of a law enforcement agency or a representative of another governmental agency, as provided by law, who is conducting official business • A child, parent, legal guardian, grandparent, grandchild, sibling, spouse or domestic partner of the registrant • An attorney representing the registrant or the registrant's estate, or any person or agency empowered by statute or appointed by a court to act on behalf of the registrant or the registrant's estate • Any individual described in paragraphs (1) to (8), inclusive, of subdivision (a) Section 7100 of the Health and Safety Code • Any funeral director or agent/employee of a funeral establishment acting within the scope of their employment who orders certified copies of a death certificate on behalf of any individual specified in paragraphs (1) to (8), inclusive of subdivision (a) of Section 7100 of the Health and Safety Code MAIL REQUESTS FOR AUTHORIZED COPIES MUST BE ACCOMPANIED BY A NOTARIZED CERTIFICATE OF IDENTITY. Those who are not authorized may receive an INFORMATIONAL certified copy with the words, "INFORMATIONAL, NOT A VALID DOCUMENT TO ESTABLISH IDENTITY" imprinted across the face of the copy. WE CAN ONLY PROVIDE COPIES FOR DEATHS THAT OCCURRED IN LOS ANGELES COUNTY. www.FormsWorkflow.com