Death Certificate Request Form

Town of West Hartford
Town Clerk - Vital Statistics
50 South Main Street
West Hartford, CT 06107
(860) 561-7430

Dear Town Clerk: Please provide me with a certified copy of a death certificate. Enclosed is a (__ ) money order /
(__ ) personal check for $10.00 each, (payable to the Town of West Hartford).

 

Death certificate for:

..

Date of death:

..

Place of death:

..
 
Please forward _____(#) certified copies of this death certificate to the following address:

Name:     

Address:

City/State:

Phone: 

 

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