City of Burlington, Vermont | Capital Improvement Projects

The City has records on file for individuals who passed away or resided in Vermont.

Place of Death *

Full Name of Person on Record *

Date of Death (mm/dd/yyyy) *

Sex *

Applicant’s Name *

Relationship to Person Whose Cert. is Requested *

Mailing Address *

City *

State *

ZIP Code *

Daytime Phone Number *

Email Address *

Identification Documents

You are required to provide a primary identification document, number and expiration date

Primary Document *

Primary Document Number *

Primary Document Expiration Date *

Primary Document Holder’s Birth Date *

Quantity Certified Copies *

Quantity Non-certified Copies *

Amount Due (does not include service fee) $0.00

Death Certificate Request