Application for Death Certificate

Application for Death Certificate - Instructions

For additional help contact Customer Support at 1-800-667-7551 or vitalstatistics@eHealthSask.ca.

While filling out your Application for Death Certificate, please read instructions carefully, print clearly and when needed refer to

the number in these instructions to be sure your information is complete for each box.

ALL INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.

(If boxes marked with an “

” are not filled in, your application is incomplete.)

ORDER DETAILS

Information

about the type of product you are requesting and the number you are ordering.

1. PRODUCT DETAILS:

Type of Product

Requested:

[See number 49 below for more

information

regarding who can apply for these

documents.]

•

Framing Size Certificate – Fee - $35.00 (No GST); Size – 21.6 cm X 17.8

cm;

o Information displayed on Certificate – the Subject’s Last Name at Death, Subject’s First Given

Name, Subject’s Second Given Name(s), Subject’s Sex, Subject’s Date of Death, Subject’s Place

of Death, Subject’s Age, Subject’s Marital Status, Subject’s Registration of Death Registration

Number and Subject’s Registration of Death

Registration

Date.

•

Certified Photocopy of Registration of Death – Fee - $55.00 (No GST); Size – 21.59 cm X 35.56 cm;

o Information displayed on Certified Photocopy – this is an exact photocopy of the Registration

of Death as registered with Health Registries and will include the signature of the registering

party(s), and amendments or corrections to the record since the original Date of Registration.

•

Genealogical Photocopy of Registration of Death – Fee - $55.00 (No GST); Size – 21.59 cm X 35.56

cm;

o Information displayed on Genealogical Photocopy – includes the same information as the

Certified Photocopy of Registration of Death and is stamped “FOR GENEALOGY ONLY”.

•

Quantity: There is a maximum limit of three (3) documents that may be ordered per application.

o You MUST print the number you are ordering in the “Quantity” box beside the “Type of Product

Requested” in order for your application to be

processed.

PLEASE NOTE: A Search Fee of $25.00 will be charged when an Application for Death Certificate is received

and a search of the Registry is conducted, but no record is found. The search fee is for a consecutive three (3)

year period search in the Registry.

[Example: If a Certified

Photocopy

of Registration is requested and a specific year is provided, the fee is

$55.00 at

the time of Application. A search of the Registry will be completed for a

consecutive

three (3) year period, [e.g.:

date provided is 1929, a search will be done for 1928, 1929, and 1930] and if a record is found, the Certified

Photocopy

of Registration will be issued. If a search of the Registry is completed for that three year period and no

record is found, there is a $25.00 Search Fee for the search and the remaining $30.00 will then be refunded.]

DEATH DETAILS

This section is to provide details of whose information is on the product you are requesting.

2. DETAILS OF PERSON NAMED ON

CERTIFICATE

[“Subject”]

PLEASE NOTE: If the Subject has been adopted, where the instructions refer to the name at birth or parents

information,

this should be the Subject’s name and parents AFTER adoption. If the Subject has completed a

legal change of name (not assuming a different last name after marriage or registering a Common Law Spousal

Relationship),

where

the

instructions

refer

the

name

birth,

this

should

the

Subject’s

name

AFTER the

legal change of name.

Subject’s Last Name at Death – This is the Last Name that the Subject used at the time of their death.

[Example: the Subject’s Last Name at Birth is Smith; they get married and assume their spouse’s last name

of Jones. The Subject’s Last Name at Death is then entered as Jones.]

Subject’s First Given Name – This is the First Name that was given to the Subject at the time of their birth.

5. Subject’s Second Given Name(s) – This is the Second Name and any other names that were given to the

Subject at the time of their birth.

6. Subject’s Last Name at Birth – This is the Last Name that was given to the Subject at the time of their birth.

[Example: the Subject’s Last Name at Birth is Smith; they get married and assume their spouse’s last

name

Jones. The Subject’s Last Name at Birth is then entered as Smith.]

Subject’s Date of Death – Month / Day / Year – Enter the date that the Subject died, by writing the month,

plus the day of the month, and full year. [Example: November 28, 2011.]

Subject’s Place of Death –

City/Town/Village/Other

– Enter the location where the Subject died by

providing the City / Town / Village or other location such as Legal Land

Description.

This MUST be a

location within

Saskatchewan

Health Registries only has records for deaths occurring in

Saskatchewan.

the Subject died in a location outside of Saskatchewan, you must apply to that jurisdiction.

9. Death

Registration

Number – If you have an old copy of the Certificate of Death or Certified

Photocopy

Registration of Death you will be able to complete this box. If you do not have the Death Registration Number,

please fill in box with N/A.

10. Subject’s Date of Birth –

Month/Day/Year

– Enter the date that the Subject was born, by writing the month,

plus the day of the month, and full year. [Example: November 28, 2011.]

11. Subject’s Place of Birth –

City/Town/Village/Other

– Enter the location where the Subject was born by

providing the City / Town / Village or other location such as Legal Land Description AND enter the

Province/State AND the Country.

12.

Subject’s Age at Death – Enter the age in years of the Subject at the time of their death. [Example: 99]

13. Subject’s Address Prior to Death – Street Address AND

City/Town/Village/Other

AND Province/State AND

Country – Enter the location where the Subject was living at the time of their Death by providing the Street

Address, the

City/Town/Village

or other location such as Legal Land Description AND enter the Province/State

AND the Country. [Example: 123 Street South

est, Edmonton, Alberta, Canada or P.O. Box

123,

14-19-08-02,

Manitoba, Canada, or 123 Avenue, New Orleans, Louisiana, USA.].

14.

Subject’s Marital Status – Never Married, Married, Widowed, Divorced or Common Law – This is the

Subject’s Marital Status at the time of their death. It is possible to select both Married and Common Law at

the same time, but no other two can be selected at the same time. [Example: both Married and Common Law

should be selected if the Subject was legally married and although the marriage ended, a Divorce was never

finalized and at the time of death, the Subject was living in a Common Law spousal relationship.]

SPOUSE’S DETAILS

This section is to provide details of the spouse(s) of whose information is on the product you are requesting.

15. Subject’s Spouse’s Last Name at Birth – This is the Last Name that was given to the Subject’s Spouse at

the time of the Spouse’s birth. [Example: the Subject’s Spouse’s Last Name at Birth is Black; they get

married and assume their spouse’s last name of Smith. The Subject’s Spouse’s Last Name at Birth is then

entered as Black.]

16. Spouse’s First Given Name – This is the First Name that was given to the Subject’s Spouse at the time of

the Spouse’s birth.

17. Spouse’s Second Given Name(s) – This is the Second Name and any other names that were given to the

Subject’s Spouse at the time of the Spouse’s birth.

18. Spouse’s Current Last Name – This is the Last Name that the Subject’s Spouse currently uses. [Example:

the Subject’s Spouse’s Last Name at Birth is Black; they get married and assume their spouse’s last name of

Smith. The Subject’s Spouse’s Current Last Name is then entered as Smith.]

19. Common Law Spouse’s Last Name at Birth – This is the Last Name that was given to the Subject’s

Common Law Spouse at the time of the Common Law Spouse’s birth. [Example: the Subject’s Common Law

Spouse’s Last Name at Birth is Black; they get married and assume their spouse’s last name of Smith. The

Subject’s Common Law Spouse’s Last Name at Birth is then entered as Black.]

20. Common Law Spouse’s First Given Name – This is the First Name that was given to the Subject’s

Common Law Spouse at the time of the Common Law Spouse’s birth.

21. Common Law Spouse’s Second Given Name(s) – This is the Second Name and any other names that

were given to the Subject’s Common Law Spouse at the time of the Common Law Spouse’s birth.

22. Common Law Spouse’s Current Last Name – This is the Last Name that the Subject’s Common Law

Spouse currently uses. [Example: the Subject’s Common Law Spouse’s Last Name at Birth is Black; they

assume their common law spouse’s last name of Smith. The Subject’s Common Law Spouse’s Current Last

Name is then entered as Smith.]

PARENTS’

DETAILS

This section is to provide details of the parents (mother, father) to the subject whose

information

is on the product

you are requesting.

23. Subject’s Mother’s Last Name at Birth – This is the Last Name that was given to the Subject’s Mother at

the time of the Mother’s birth. This is also referred to as the Mother’s Maiden Name. [Example: the Subject’s

Mother’s Last Name at Birth is Black; she gets married and assumes her spouse’s last name of Smith. The

Subject’s Mother’s Last Name at Birth is then entered as Black.]

24. Mother’s First Given Name – This is the First Name that was given to the Subject’s Mother at the time of the

Mother’s birth.

25. Mother’s Second Given Name(s) – This is the Second Name and any other names that were given to the

Subject’s Mother at the time of the Mother’s birth.

26. Mother’s Current Last Name – This is the Last Name that the Subject’s Mother

currently

uses. [Example:

the Subject’s Mother’s Last Name at Birth is Black; she gets married and assumes her spouse’s last name of

Smith. The Subject’s Mother’s Current Last Name is then entered as Smith.]

27. Mother’s Place of Birth –

City/Town/Village

AND Province/State AND Country – Enter the location where

the Subject’s Mother was born by providing the

City/Town/Village

or other location such as Legal Land

Description AND enter the Province/State AND the Country. [Example: Edmonton, Alberta, Canada or

14-19-08-02,

Manitoba, Canada, or New Orleans, Louisiana, USA.]

28. Subject’s Father’s Last Name at Birth – This is the Last Name that was given to the Subject’s Father at the

time of the Father’s birth. [Example: the Subject’s Father’s Last Name at Birth is Jones; he gets married and

assumes his spouse’s last name of Smith. The Subject’s Father’s Last Name at Birth is then entered as

Jones.]

PLEASE NOTE: The details regarding the Subject’s Father’s

information

are important even if it is unknown if the

Subject’s Father’s details are on the original Death

Registration.

The applicant should complete all boxes

possible,

but if details are unknown, please fill in box with N/A.

29. Father’s First Given Name – This is the First Name that was given to the Subject’s Father at the time of the

Father’s birth.

30. Father’s Second Given Name(s) – This is the Second Name and any other names that were given to the

Subject’s Father at the time of the Father’s birth.

31. Father’s Current Last Name – This is the Last Name that the Subject’s Father

currently

uses. [Example: the

Subject’s Father’s Last Name at Birth is Jones; he gets married and assumes his spouse’s last name of

Smith. The Subject’s Father’s Current Last Name is then entered as Smith.]

32. Father’s Place of Birth –

City/Town/Village

AND Province/State AND Country – Enter the location where

the Subject’s Father was born by providing the

City/Town/Village

or other location such as Legal Land

Description AND enter the Province/State AND the Country. [Example: Edmonton, Alberta, Canada or

14-19-08-02,

Manitoba, Canada or New Orleans, Louisiana, USA.]

APPLICANT DETAILS

This section is to provide details about the applicant, delivery and reason for the request.

33.

THE

FOLLOWING

MUST BE

COMPLETED

BY THE PERSON APPLYING FOR THE DEATH

CERTIFICATE [“Applicant”]

[See number 49 below for more information regarding who can be an

“Applicant”.]

PLEASE NOTE: If the applicant has been adopted, where the instructions refer to the name at birth or parents'

information,

this should be the applicant’s name and parents AFTER adoption. If the applicant has completed a

legal change of name (not assuming a different last name after marriage or registering a Common Law Spousal

Relationship), where the instructions refer to the name at birth, this should be the applicant’s name

AFTER the legal change of name.

A readable

photocopy

of the applicant’s

identification

MUST be attached to this Application for Death

Certificate.

Identification is required as proof that you are the one completing the Application for Death Certificate and that

someone has not used your identity illegally.

Identification

that is required is either one (1) piece of

government-issued

photo identification OR two (2) other

pieces of identification – one (1) MUST have your signature and the identification provided MUST be valid.

Please provide a readable

photocopy

of both sides of the identification.

Never send your original

identification

with your Application. eHealth accepts no liability for any loss or

damage that may occur.

Examples of

government-issued

photo

identification

are:

•

Saskatchewan

Photo Driver’s License – valid / non-expired

•

Canadian Indian Status Card – credit card style issued by the

Government

of Canada

•

Canadian Indian Status Card – laminated Polaroid style

•

Canadian Passport – valid / non-expired

•

Canadian Citizenship Card – valid / non-expired

•

Foreign Passport – (meets the two-piece identity requirement)

valid/non-expired

and must be

accompanied with one (1) of the Citizenship and Immigration Canada (CIC) documents:

o Record of Landing – issued under the

Immigration

and Refugee Protection Act (Canada);

o Refugee Protection Claimant document (CIC);

o Study permit – issued under the Immigration and Refugee Protection Act (Canada);

Temporary

Residence Card (CIC);

o Visitor record – issued under the Immigration and Refugee Protection Act (Canada);

o Work permit – issued under the Immigration and Refugee Protection Act (Canada)]

•

Canadian Jurisdiction Driver’s License – valid/non-expired

Examples of other forms of

identification

are:

•

Birth Certificate

•

Health Services Card – valid non-expired

•

Certificate of Change of Name

•

Court Order – containing the person’s birth date and legal name, and sealed with the court’s seal

•

Utility bill –

(SaskEnergy,

SaskPower, SaskTel or

ater)

•

Bank statement or cancelled cheque – with the person’s home address

•

Mortgage document

•

Residential lease

•

Personal income tax document – with the person’s address

•

Employment

confirmation

•

Social assistance benefit confirmation

•

Student Identification Card – valid / non-expired

•

Library Card – valid / non-expired

Other documents may be accepted by special

arrangement.

Please contact eHealth to discuss BEFORE you

submit your Application for Death Certificate.

34.

Applicant’s First Given Name – This is the First Name that was given to the applicant at the time of their

birth or variation that is used at the time of applying.

PLEASE NOTE: If this is the name that the applicant

normally

uses, this name must match that as shown on the

identification

submitted with the

Application

for Death Certificate. Also, this is the name that will be used for the

purposes of contact by Health Registries when the document(s) requested are issued and if there is a need to

obtain further

information

from the applicant.

35. Applicant’s Second Given Name(s) – This is the Second Name and any other names that were given to the

applicant at the time of their birth.

PLEASE NOTE: If this is the name that the applicant

normally

uses, this name must match that as shown on the

identification

submitted with the

Application

for Death Certificate. Also, this is the name that will be used for the

purposes of contact by Health Registries when the document(s) requested are issued and if there is a need to

obtain further

information

from the applicant.

36.

Applicant’s

Current Last Name – This is the Last Name that the applicant currently uses. [Example: the

applicant’s Last Name at Birth is Doe; they get married and assume their spouse’s last name of John. The

Subject’s Current Last Name is then entered as John.]

PLEASE NOTE: If this is the name that the applicant

normally

uses, this name must match that as shown on the

identification

submitted with the

Application

for Death Certificate. Also, this is the name that will be used for the

purposes of contact by Health Registries when the document(s) requested are issued and if there is a need to

obtain further

information

from the applicant.

37.

Mailing Address: Apartment # – Street # – Street Name – P.O. Box – This is the address that will be

used for the purposes of contact by Health Registries when the document(s) applied for are issued and if

there is a need to obtain further

information

from the applicant.

38. If Mailing Address is to a Business, Attention – If the applicant wants the document(s) applied for to be

sent to a business, this box must have the name of the person who is to receive the

document(s)

from Health

Registries. [Example: the applicant wants the document(s) to be sent to their lawyer. The applicant would

provide their own name in boxes 36, 37 and 38; they would provide their lawyer’s address in box 39 “Mailing

Address” and then completes this box by putting in their lawyer’s name.]

39.

City/Town/Village/Other

– The City, Town, Village or other location where the Mailing Address is located.

40.

Province/State

– The Province or State where the Mailing Address is located.

41.

Country – The Country where the Mailing Address is located.

42. Postal/Zip Code – The Postal Code or Zip Code where the Mailing Address is located.

43. Telephone – Home – This is the applicant’s home telephone number that can be used if Health Registries

must contact the applicant.

44. Telephone – Work/Cell – This is the applicant’s work or cell telephone number that can be used if Health

Registries must contact the applicant.

45. Email – This is the applicant’s email address that can be used if Health Registries must contact the applicant.

46.

Reason Why Certificate is Requested – This information is used to determine if the applicant is eligible to

receive the

document(s)

being applied for and to assist the applicant in obtaining the right document.

47.

Applicant’s

Relationship

to Person Named on Certificate – Spouse/Mother/Father/Other

Parent/Daughter/Son/Other:

- This is the applicant’s relationship to the person who is named on the

document being requested. There are specific rules about who can receive Death

information

from Health

Registries. The standard examples of who is allowed to receive Death information are:

•

If you are the Married Spouse of the Subject, and you are listed as the Married Spouse on the original

Registration of Death, you would select Spouse.

•

If you are the Common Law Spouse of the Subject, and you are listed as the Common Law Spouse on

the original

Registration

of Death, you would select Spouse.

•

If you are the Mother of the Subject, and you are listed as the Mother on the original

Registration

Death, you would select Mother.

•

If you are the Father of the Subject, and you are listed as the Father on the original Registration of Death,

you would select Father.

•

If you are the Other Parent of the Subject, and you are listed as an Other Parent on the original

Registration of Live Birth for the subject, you would select Other Parent.

•

If you are age 18 or older, the Daughter of the Subject, and the Subject is listed as a parent on your

original Registration of Live Birth, you would select Daughter.

•

If you are age 18 or older, the Son of the Subject, and the Subject is listed as a parent on your original

Registration of Live Birth, you would select Son.

•

If you are the Legal Guardian of the Subject, you would select Other and on the line provided you would

print “Legal Guardian”. You MUST then include with the application the documents to prove you are the

Legal Guardian.

•

If you are the Executor of an Estate and you are requesting the Death Certificate of the person who is

deceased, you would select Other and on the line provided you would print “Executor”. You MUST then

include with the application the documents to prove you are the Executor.

•

If you are the personal or property guardian or other legally appointed representative of the Subject, you

would select Other and on the line provided you would print an explanation as to your legal relationship.

You MUST then include with the application the documents to prove that legal relationship.

PLEASE NOTE: You are not an eligible applicant and your Application will not be processed IF:

•

You are applying for your

Grandmother,

Grandfather, Aunt, Uncle, Cousin, Sister, or Brother’s Death

Certificate,

•

You are a friend of the Subject.

If you are not an eligible person, in order for your Application to be processed, you MUST provide an

Authorization

Form completed by an eligible person AND a readable

photocopy

of two (2) documents to

establish the identity of that eligible person with your Application for Death Certificate, your identification

and payment.

48.

Method of Delivery

Requested: Mailed/Picked

Up/Urgent Service – The applicant must select the

method of delivery so that Health Registries knows how the applicant would like to receive their requested

document(s).

49.

Payment Method: CANADIAN FUNDS ONLY

PLEASE NOTE: eHealth is not responsible for delays in shipping.

•

Mailed – If an application is complete, the information given in the application agrees with our records

and the event has been registered, you will be mailed your order when ready.

•

Picked Up – Documents can only be picked up in person at the Regina Health Registries

Office. W

hen

you arrive to pick up your documents, you MUST have identification with you that matches the information

on the Application for Death Certificate.

PLEASE NOTE: If you are the applicant and want someone else to pick up your documents, you MUST provide

Authorization

Form and a readable

photocopy

of your identification to that person and when that person

arrives to pick up your

documents,

they MUST have identification that matches the information on the

Authorization Form.

•

Urgent Service -

here rush service is required for a birth, death, or marriage certificate, clients may be

able to request this Urgent Service option. If the application is complete, the

information

agrees with our

records and the event is registered, the order will be processed as soon as possible.

In order to request Urgent Service, one of the following criteria must be met.

a) Immediate Travel – the client has already booked their holiday. The client must provide proof of

the booking (i.e. trip itinerary).

Emergency

Travel – the client must travel due to personal

emergency

(i.e. family death occurred

out of province).

You can request your documents be sent by courier or you can pick-up. Documents are available for pick-

up during regular business hours in Regina only.

When picking up the

documents,

the following must be provided or the document will not be released:

•

the client must present identification

•

if picking up for someone else, the person picking up the document must have written

authorization

from the other party; plus identification

The Urgent Service fee is $30.00 and is charged on a per order basis in addition to the cost of the

requested documents.

PLEASE NOTE: There is a $30.00 fee if you meet the criteria. This fee is in addition to the fee for the

document(s) requested. [Example: The applicant completes the Application for Death Certificate and is ordering

one (1) Framing Size Death Certificate for $35.00 and one (1) Certified

Photocopy

of Registration of Death for

$55.00 for a total of $90.00. The applicant then selects Urgent Service for an additional $30.00. The total amount

due for the order is $120.00.]

PLEASE NOTE: eHealth does not accept

International

Money Orders, USA Cheques, American Express, VISA

Debit Cards or

MASTERCARD

debit cards.

a) Debit or Cash - is accepted in person only at our Regina location. It is against Postal Regulations to

send Cash in the mail.

b) Cheques and Money Orders - must be made payable to eHealth

Saskatchewan

and must be in

Canadian funds. If you are paying by cheque, your request will be held for 6 business days until the

bank notifies Health Registries that your cheque has cleared.

c) Visa and

MasterCard

- MUST be made by completing a Payment Information Form and attaching

it to the Application for Birth Certificate.

50.

Payment Amount – Please print the payment amount being provided.

51.

Signature of Applicant – The applicant MUST sign the Application for Birth Certificate. The signature

MUST be the applicant’s

ordinary

signature and MUST be written entirely in the characters of the Roman

alphabet.

52.

Date Applicant Signed

Application

- Month / Day / Year – The applicant MUST provide the date on which

they signed the Application for Birth Certificate.