ARE YOU ORDERING
A VITAL RECORD BY MAIL
?
No record will be provided unless you:
Sign the form
AND
Include a photocopy of your ID
See form for details.
Thank you!
Oregon Vital Records
45-13B (04/21)
Certied, long form with cause of death
Oregon Death Record
ORDER FORM
Certied, fact of death
(Available 1978 through the present.)
$25 each certicate
QUANTITY
QUANTITY
Center for Health Statistics
WARNING: Providing false information is a felony under ORS 432.993
$25 FOR THE FIRST RECORD; $25 FOR EACH ADDITIONAL COPY.
The rst $25 fee is non-refundable once the search for the record has been completed.
OAR 333-011-0340(1).
This form is available in alternative formats. See second page for details.
Non-Sucient Funds (NSF) check
processing policy: In the event that your
check is returned unpaid for insucient
or uncollected funds, we may present
your check electronically. In the ordinary
course of business, your check will
not be provided to you with your bank
statement, but a copy can be retrieved
by other means. A penalty, not to exceed
$35, may be assessed for NSF checks
per ORS 30.701(5).
See second page of form for
ordering options and processing times.
Information is also available on our Web
page at: www.healthoregon.org/chs or
by calling 971-673-1190.
ENTER YOUR MAILING ADDRESS
THIS SECTION WILL BE DETACHED AND USED AS A MAILING LABEL
Name
Street
City State ZIP
1. Full name of deceased:
(rst) (middle) (last)
2. Date of death: 3. Place of death: OREGON
(mm/dd/yyyy) (city) (county)
4. Spouse of decedent:
(rst) (middle) (last name prior to rst marriage)
5. Your relationship to person named in line 1 above:
6. Reason for needing record:
7. Daytime telephone number: 8. Email:
9. Name of person ordering:
10. Your address:
11. City/State/ZIP:
12.
c
Person ordering: Attach legible photocopy of current, valid ID or legal representative
document and representative’s ID. See back of form for alternative ID options.
13. Required signature of person ordering:
In accordance with law ORS 432.380, access to death records is restricted for 50 years to
immediate family members, legal representatives, government agencies and persons with a personal
or property right. Legal guardians must enclose a copy of the legal document and ID. If you are not
eligible, enclose a written permission note with a notarized signature of the eligible person.
Send to:
OREGON VITAL RECORDS
PO BOX 14050
PORTLAND OR 97293-0050
Make checks/money orders payable to:
OHA/Vital Records
PLEASE DO NOT SEND CASH
Checks/money orders in U. S. Dollars
OFFICE USE ONLY
DO NOT WRITE IN THIS SPACE
Certicate number:
1 2
Film
Film (P)
Computer
Indexes
Index (P)
DF/CO
Refund: $
Excess fee
No record
Out/state
Uncompleted
Check #:
File date: Amendment fee:
NRL/Ref issued: Full issued:
Follow-up: Computer copy:
Drop Box Location:
800 NE OREGON ST
PORTLAND OR 97232
Print
Save as
Reset form
Alternative identification you can send with your mail or drop box order.
If you don’t have a valid driver’s license, ID card or passport, send photocopies of three (3) different documents
that include both your name and current address. Suggested documents are listed below. If you are mailing
your order or using the drop box, make photocopies of the documents and include them with your order form.
Documents must be dated within the last 30 days and show applicant’s current mailing address.
Documents such as:
• Utility bill (for example, telephone, gas, electric, water, garbage removal) or other bill;
• Insurance statement, medical statement or paycheck stub,
must have current mailing address and can be no more than 30 days old.
Other documents such as:
• Court or parole documents;
• Valid work ID, unemployment statement, food stamp or other benet cards (copy both sides);
• Permit for rearms, shing, hunting or other license;
• Vehicle registration, title or insurance statement,
may be used. However, expired documents are unacceptable. For more information on acceptable
documents, go to www.healthoregon.org/chs, click on “Information Needed to Order,” and scroll
down to “Acceptable Proofs of Identity.”
If you have no ID or other documents, an immediate family member can provide ID and order the record. Records
may also be released to a legal representative of a family member or sent directly to a government agency.
How long does it take to receive a record ordered by mail? Processing times vary between three and ve
weeks depending on seasonal workload. To ensure fast processing for mail orders, use a money order instead of a
personal check. Payment by personal check may delay processing by three weeks if the check is on a new account,
is a temporary check, does not include a printed name or address, or has a change to the printed name or address.
If an amendment is being processed or the record is not on le, or ID or information is missing or in error, expect an
additional delay of two to four weeks.
Order in person and receive the record within 30 minutes – 1 hour. Additional fees apply. Fees are not
refundable after orders are submitted.
State Vital Records Oce: 800 NE Oregon Street, Suite 205, Portland, OR 97232-2162
Oce Hours: 9:00 a.m. to 4:00 p.m., Monday through Friday.
Orders must be submitted by 3:30 p.m. to receive the same day.
Ordering in person is limited to immediate family members of the person named on the record and persons with a
personal or property right. Orders are placed at self-service kiosks. The identity of the applicant will be screened
using Social Security number and date of birth. Additional fees apply. Persons ordering must show valid ID or provide
alternative documents. In some cases, proof of relationship may be required if the person ordering does not share
the last name of the person on the record and is not clearly a family member. Payment by credit or debit card, cash,
money order or electronic funds transfer (EFT) of a personal check is accepted.
Order online: www.vitalchek.com at any time. Additional fees apply.
Order by telephone through VitalChek: 1-888-896-4988, 24 hours per day, 7 days per week, except for major
holidays. Additional fees apply. Fees are not refundable. All major credit/debit cards accepted. Orders are processed
through the VitalChek Network. Additional fees apply per order to cover vendor, security and expedite fees. Overnight
shipping available for an additional fee that varies depending on the vendor and place of delivery. Records will be
mailed/shipped within three working days of receipt unless a record problem is discovered. Shipments can be delayed
for missing or incorrect information, or if records are still being registered or amended.
45-13B (04/21)
This document can be provided upon request in an alternate format for individuals with disabilities or in
a language other than English for people with limited English skills. To request this publication in another
format or language, contact 971-673-1190 (voice) or 711 (TTY), or fax 971-673-1203.
