Apply by Mail

1. To Obtain an Affidavit of Amendment of a Certificate of Death, the applicant has to approach the ARKANSAS DEPARTMENT OF HEALTH link
2. An application form will be provided to the applicant by the concerned officer or contact the health office.
3. The applicant has to enter all the details in the application form.
4. Make sure that the applicant has to attach all the necessary documents that are mentioned in the “Required Documents” section of this page.
5. Also, the applicant needs to complete the Supplemental Medical Certification form.
6. To get the medical certification form, the applicant needs to contact the public health centre - (334) 206-2641 or fax a request letter to - (334) 206-2659.
7. Once the application form is collected, the applicant needs to complete the form and submit it along with the amendment of death certification.
8. The applicant has to attach the photocopies of the required documents along with the application form while submitting.
9. Submit all the necessary documents along with the completed form to the Public Health Mailing address.
10. The mailing address is mentioned in the “Office Locations & Contacts” section of this page.
11. The fee for this procedure is mentioned in the “Fees” section of this page.
12. After receiving the application, the concerned authority will check the submitted application and document set. If all are in place, the application will be accepted.
13. Then the application will be processed further. All the updates on the application status will be sent via SMS to the applicant’s mobile number.
14. Once the process gets completed, the applicant gets the death certificate through mail.
15. The processing time for this procedure is up to 15 – 30 days.

• Application form
• Identity proof (two type of proof document required)
• Address proof (two type of proof document required)
• Death certificate
• Medical certificate
• Court order
• Fee receipt

ARKANSAS DEPARTMENT OF HEALTH
Mailing address: Amendments Department
4815 West Markham Slot 44
Little Rock, Arkansas 72205
Phone: (501) 682-1214)
Fax: (501) 661-2869)
Contact link

• An immediate family member of the decedent and the person who is applied for death certificate is eligible to make this application.

• The fee to amend a death certificate is $10.00
• Additional copies of the same record ordered at the same time are $8.00 each.

• The validity of amendment certificate is valid forever.

Please attach documents that can be used by people. e.g. links

Please attach sample completed documents that would help other people.

• The processing time for this procedure is up to 15 – 30 days.

Videos explaining the procedure or to fill the applications.
Attach videos using the following tag <&video type='website'>video ID|width|height<&/video&> from external websites.
Please remove the '&' inside the tags during implementation.
Website = allocine, blip, dailymotion, facebook, gametrailers, googlevideo, html5, metacafe, myspace, revver,
sevenload, viddler, vimeo, youku, youtube
width = 560, height = 340, Video ID = Can be obtained from the URL of webpage where the video is displayed.
e.g In the following url 'http://www.youtube.com/watch?v=Y0US7oR_t3M' Video ID is 'Y0US7oR_t3M'.

• Applicant must complete the application form before submitting. Incomplete applications will not be accepted.
• Applicant must provide genuine information while applying for this procedure.

• LEGAL NAME OF DECEASED
• Date of Death
• Date of Birth
• Country of Death
• Hospital
• Number of copies requested
• Legal name of deceased
• With cause of death
• Without cause of death
• Requesting changes

• An affidavit is a type of verified statement or showing, or in other words, it contains a verification, which means that it is made under oath on penalty of perjury, and this serves as evidence for its veracity and is required in court proceedings.
• Amending Death certificate means of correcting or completing information that prints on a Death certificate. If there is any correction or missing information in the Death record, the applicant needs to request for an amendment.

The process to amend or correct a death certificate varies greatly depending on factors such as:

• The laws of the state that issued the death certificate
• The reason(s) to amend the death certificate
• The eligibility of the applicant to make the changes

• The death certificate is used has proof of identity

Link

Reason of amendment death certificate

• Correct a spelling mistake or other errors
• Add missing information
• Add on of left out medical information