Genealogy-Death

      Canton City Health Department
                            James M. Adams, R.S., M.P.H., Health Commissioner

                          Promoting and Protecting Health Since 1849

420 Market Ave. North
Canton, Ohio 44702
(330) 489-3231
(330) 489-3335 (fax)
Info@cantonhealth.org

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Genealogy Request Form - Death
(PLEASE PRINT OR TYPE)

Death Record Requested for:

Date of Death (1908-1962)
(After 1962 - Exact date or 3 year range)

Father's Name:

Mother's Maiden Name:

Your Name:

Your Street Address:

Your City: State: Zip Code:

I would like certified copies @ $18.00 per copy.

OR, I would like the following information provided at no cost:

If the microfilm we are reading from is not clear enough to provide you with exact information, we will provide the information that is legible and include a form to submit to the Ohio Department of Health. Original copies are held by the Ohio Department of Health and legible copies can usually be obtained from them.