NorthCarolinaOfficeofVitalRecords
DeathCertificateAmendmentProofRequirements
DeathCertificateFieldModification
RequiredProofs
•RailroadBenefitsStatement1099‐Rforrailroadretirees;OR
•DD214;OR
•Courtorderreflectingtheinformationrequestedtobeamended
PlaceofDeath
•Signedstatementfromthemedicalcertifierorthemedical
examinerwhosignedthedecedent'sdeathcertificate.Ifthe
certifierisunavailable,thestatementmaybesigned
bythe
certifier'sauthorizedmedicalassociateorthechiefmedicalofficer
forthecertifier'sfacility
•Signedstatementfromthetransporterwhoremovedthe
remainsfromtheplaceofdeath;OR
•Signedstatementfromthefuneraldirectorwhowitnessedthe
removalofremainsfromtheplaceofdeath;OR
•Treatment
reportfromtheemergencymedicalservicesprovider
thatremovedtheremainsfromtheplaceofdeath;OR
•Courtorderreflectingtheinformationrequestedtobeamended
ChangingPlaceofDeathTypetoFacility
•Statementfromfacilitydirectoronletterheadthatverifies
decedentlivedinthefacility;OR
•Signedstatement
fromthemedicalcertifierorthemedical
examinerwhosignedthedecedent'sdeathcertificate.Ifthe
certifierisunavailable,thestatementmaybesignedbythe
certifier'sauthorizedmedicalassociateorthechiefmedicalofficer
forthecertifier'sfacility;OR
•Courtorderreflectingtheinformationrequestedtobeamended
Countyof
Death
•Signedstatementfromthemedicalcertifierorthemedical
examinerwhosignedthedecedent'sdeathcertificate.Ifthe
certifierisunavailable,thestatementmaybesignedbythe
certifier'sauthorizedmedicalassociateorthechiefmedicalofficer
forthecertifier'sfacility;OR
•Signedstatementfromthetransporterwho
removedthe
remainsfromtheplaceofdeath;OR
•Signedstatementfromthefuneraldirectorwhowitnessedthe
removalofremainsfromtheplaceofdeath;OR
•Treatmentreportfromtheemergencymedicalservicesprovider
thatremovedtheremainsfromtheplaceofdeath;OR
•Courtorderreflectingthe
informationrequestedtobeamended
ArmedForcesAffiliation •Militarydischarge(DD214);OR
•VAIdentificationcard;OR
•Notarized,statementfrominformantorclosestfamilymember
thatdecedentneverservedinthemilitary(to removearmed
forcesmarker);OR
•Courtorderreflectingtheinformationrequestedtobeamended
Updated09/2022