Mississippi Death Certificate Application

ID Requirements must be met before certificate is issued. You will receive an email with instructions on how to send your ID within one week of submitting this application.

Items with an * asterisk are required fields.

Important: The online Vital Certificate Processing Fee is payable upon ordering and the relevant Vital Statistics Agency Fee and any other shipping fees are payable upon review and acceptance by the State Agency and will appear on your credit card statement separately.

Please note: All state certificate fees are subject to change without notice.

1. Information About the Certificate

Certificate Type *State / Territory *County where the death occurred *City / town where the death occurred *Enter the city or town where the death occurred.Reason for requesting this certificate *

2. Information About the Requestor

Your relationship to the person named on the certificate *Your first name *Your middle nameYour last name *

Your date of birth

3. Information About the Subject

Person named on the death record.

Deceased first name *Middle name Deceased last name *Date of death *Date of birth, if known Age at death, if known Sex / gender as recorded

4. Parent / Family Information

Place of death

Facility or place of death, if known Hospital, care facility, residence, or other location.

5. Shipping & Contact Information

Requirements: The Shipping Address Name must match the Requestor Name.

Home Address

Information about the Home Address Name: The name on the Home Address Name must match the Requestor Name.

Home Address Type *

First Name

—

Last Name

—

Address Line 1 *Address Line 2 (optional)City *State *Zip/Postal Code *

Is your Shipping Address the same as your Home Address? Yes NoYour Home Address will be copied below when you choose Yes. You can still edit it.

Shipping Address

Shipping Address: If certificate is delivered by UPS, it must be signed for at this address. Certificates delivered by UPS cannot be sent to a P.O. Box.

Shipping Address Type *

First Name

—

Last Name

—

Address Line 1 *Address Line 2 (optional)City *State *Zip/Postal Code *

Contact information

Phone number *

Email address *Order confirmation, tracking, and updates are sent to this address.Confirm email address *

6. Copies & Processing

Number of Copies *Each copy includes the $125.00 USVC Processing Fee.Delivery Method *

Regular mail delivery is available, however, we recommend you choose a more secure shipping method that provides faster delivery and tracking of your order.

Processing speedStandard ProcessingYour application is prepared and processed using our standard service workflow. Processing typically takes 5–7 business days.IncludedRush ProcessingYour application will be processed the next day.+$30.00 per order

Processing times refer to USVC's processing of your application. Government agency processing and certificate delivery times may vary.

7. Billing Details

Requirements: The Billing Address Name must match the Requestor Name.

Your billing address is used to verify your payment. Card details are collected in the Credit Card Details section below.

Is your Billing Address the same as another address? Same as Home Address Same as Shipping Address Neither — Enter Billing AddressThe selected address has been copied below. You can still edit it.

Billing Address

County Requirements: For the selected County, the Billing Address Name must match the Requestor Name.

Billing Address Type *

First Name

—

Last Name

—

Address Line 1 *Address Line 2 (optional)City *State *Zip/Postal Code *

8. Credit Card Details

Important: We currently accept Visa and Mastercard only. Other forms of payment, including American Express, Discover and digital wallets, are not supported at this time.

Credit Card Number *

Credit Card Expiry Date (MM/YY) *CVV *

Important: This is a 3-digit code on the back for Visa and Mastercard.

9. Order Summary

Mississippi Death Certificate

Number of copies: 1 certified copy

Online Processing Fee$125.00 per copy × 1$125.00

TOTAL$125.00

This total includes the USVC Processing Fee and Rush Processing when selected. The relevant Vital Statistics Agency Fee and any other shipping fees are payable upon review and acceptance by the State Agency and will appear on your credit card statement separately.

10. Review To Submit

Certificate

Certificate: Mississippi Death Certificate
County: —
City / town: —
Reason: —

Subject of the certificate

Deceased first name: —
Middle name: —
Deceased last name: —
Date of death: —
Date of birth, if known: —
Age at death, if known: —
Sex / gender as recorded: —

Parent / Family Information

Facility or place of death, if known: —

Requestor & contact

Name: —
Relationship: —
Date of birth: —
Phone: —
Email: —
Home: United States
Ship to: United States
Bill to: United States

Copies, processing & fees

Number of copies: 1
Processing speed: Standard Processing
Online Processing Fee: $125.00
Rush processing: Not selected
Payment card: —
Total: $125.00

Electronic Signature *Typing your name serves as your electronic signature for this order.

I agree to all of the statements below. Selecting this checks every item; you may also review and select them individually. I certify that the information provided is accurate to the best of my knowledge and that I am authorized to request this record. I understand I will receive an email from the relevant government agency with instructions on how to send a copy of my government issued picture ID for verification. I agree to the Terms of Service. I have read the Privacy Policy. I accept the Refund & Cancellation terms. I understand USVC is an independent service, not a government agency, and that the Vital Statistics Agency Fee and any other shipping fees are payable upon review and acceptance by the State Agency and will appear on my credit card statement separately. Authorization for the complete order payment. I authorize USVC to charge the Vital Certificate Processing Fee shown on my order. The relevant Vital Statistics Agency Fee and any other shipping fees are payable upon review and acceptance by the State Agency and will appear on my credit card statement separately.

11. Payment

Continue to the secure payment step to complete your order. Your card details are encrypted before storage and are visible only to authorized staff for government-agency processing.

Total $125.00 — one all-inclusive payment