Order Death Certificates

Death Certificates can only be obtained from deaths that have occurred within the past two months and have taken place in Lewis County.

Certificate Information

First Name

Middle Name

Last Name

Date of Birth

Date of Death

Location of Death

Mother's First Name

Mother's Middle Name

Mother's Maiden Name

Father's First Name

Father's Middle Name

Father's Last Name

Birth Location

Quantity (Certificates cost $20.00 each)

Quantity

Delivery Preferences

Delivery Method

Mailing Information (The certificate will be mailed here upon payment)

If you do not provide a name and address the certificate cannot be mailed.

Address To

Street Address

Address Line 2

City

State

Zip Code

Notes or Comments Regarding Your Order

Message

Please note: If you plan on purchasing this certificate with an electronic check (not a debit or credit card), there will be a two week waiting period to verify funds.

Notice

Picking Up An Order?

If you complete this order form and request to pick up your certificate(s) instead of having them shipped, you can retrieve them at the Lewis County Public Health office here:

360 NW North Street
Chehalis WA 98532

If you are having any trouble with this order form, please contact us at:
(360) 740-1223

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