floridahealth.gov Application for Correction in Death Certificate : Florida Department of Health

Name of the Organization : Florida Department of Health
Type of Facility : Application for Correction in Death Certificate
State : Florida
Country : United States of America

Website : http://www.floridahealth.gov/certificates/certificates/amendments-corrections/index.html
Application Form : https://www.statusin.org/uploads/24077deathapplication.pdf
Download Instruction : https://www.statusin.org/uploads/24077-Instructions.pdf

Application for Correction in Death Certificate :

Instructions For Correction Of Certificate Of Death :
1. The Application For Amendment To Florida Death Record (Dh 524), Completed And Returned With $20.00 Fee.
2. This Fee Entitles You To One Certified Copy Of The Amended Record.

Related : Florida Department of Health Ordering a Death Certificate : www.statusin.org/24058.html

3. The Affidavit Of Amendment To Certificate Of Death (Dh 433), Completed According To Instructions On The Reverse Side.
4. Documentary Evidence where required. (See instructions below for corrections that require submission of evidence.

** The AFFIDAVIT is sufficient for correcting some minor errors. Other corrections require documentary evidence in addition to the affidavit.
Corrections requiring evidence are :
** Name Of Deceased (other than misspelling)*
** Date Of Birth (changed more than 3 months)*
** Citizenship From Alien To United States Citizen*
** Names Of Parent(S) (other than a misspelling or transposition of given names)

Suggested Sources Of Documentary Evidence :
Note :
** *Certified copy of decedent’s birth record preferred.
** However, two documents supporting the correction may be substituted.
** Must substantiate the facts to be corrected and contain the date the original document was originally established.

Birth Certificate :
** May be obtained from the state where the birth occurred.
School Record :
** May be obtained from the county superintendent or principal of school on official letterhead, affidavit form or be a certified transcript.
** You may visit the website at fadss.org/

Census Record :
** Bureau of the Census, P. O. Box 1545, Jeffersonville, Indiana 47131.
** A substantial fee is required thus we usually do not suggest this unless a last resort.
** You can visit the website at census.gov/

Social Security Record (Numident):
** Social Security Administration, OCRO – EEU,P. O. Box 33022, 33 N. Greene Street, Baltimore, Maryland 21290.
** A fee is required.
** You may also wish to contact your local social security office to see if a social security numident can be obtained locally.

Passport, Military Record, Driver License :
** Original or certified photocopy of any of these records should prove name and place of birth, and date the original record was established.

Employment Record :
** Contact the manager or personnel director of the company by which registrant was employed and secure an official statement of facts of the birth as shown on their records.
** This statement must include date on which the employment record was originally made.

Voting Registration Record :
** An Old Voting Registration Record Should Prove Name, Age, And State Of Birth.
** Medical Treatment Record
** Insurance Record
** Other Applicable Vital Records, I.E., Birth Certificate Of Parent(S) OrChild, Marriage Certificate For Decedent Or Parent(S).
** Other Records Which Are Verifiable May Be Substituted.

Date Of Death And/Or Place Of Death :
** May be submitted on Affidavit of Amendment to Medical Certification of Death (DH Form 434) if no correction to personal identifying information also being requested.
** If submitted on this form signed by the attending physician or medical examiner, no amendment fee is required.

** If there are ALSO corrections to any personal identifying information in addition to these two items,

** you may include all the corrections on the Affidavit of Amendment to Death Record,DH Form 433 together with a statement from the attending physician or medical examiner supporting the correction as well as any other documentary evidence which may be required and the required amendment fee of $20.00.