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2. Death Certificate Request Form

   The North Attleboro Clerk issues certified copies of the records of death of any person whose death occurred within the town limits of North Attleboro, Massachusetts. If you are not certain whether a death record is filed with North Attleboro Clerk, call the office for confirmation at 508-699-0142 before ordering.

   Please note that Death Certificates are recorded in the community where the death occurred and in the community in which the decedent resided at the time of death.

   Records of deaths occurring outside of Massachusetts are not available.

4. Decedent
6. First Name:*
7. Last Name:*
9. Location of Death*
10. Date of Death*
    Date of Death
12. Number of copies requested:*
    -- Select One --12345678910

    Fee: $10 per copy

16. Requested By:
18. First Name*
19. Last Name*
21. Address*
23. City*
24. State*
25. Zip Code*
27. Phone Number*
29. Please print out this completed form and submit to the Town Clerk's office along with payment and self-addressed stamped envelope
Leave This Blank:


30. Print Only

* indicates a required field