Connecticut Order Form

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.

Information About the Certificate

City/County of :  Please select the exact city and county of death for the subject of the certificate.

City is required
County is required

Date of Death:  The exact date of death of the person listed on the record.

Date of Death must be within valid range
Click the MM-DD-YYYY field to open the calendar. Click on THE YEAR to type the correct year. Use the arrows to navigate to the month and then select the day.

Year of Death Restriction:  For the selected county we can only accept orders for deaths that occurred from 2010 to today.


Information About the Requestor

IMPORTANT:  The requestor is the person ordering the certificate. The name of the credit card holder must be the same as the requestor.

First Name is required
Last Name is required

Date of Birth & Social Security Number of the Requestor:  This is an additional safeguard to protect your identity and the security of the requested certificate.

Valid Date of Birth required

Important:  Valid SSN only, no ITINs or temporary SSNs permitted.

Valid SSN is required
Request reason required

Information:  If you are not named on the record you may be required to provide proof of Relationship, Entitlement, and/or Court Documents.

Important:  The relationship selected must match your relationship to the subject exactly

Relationship required

Information About the Subject of the Certificate

ADOPTED?  Please visit our FAQ section for important information.

Name of Subject:  The name exactly as it appears on the certificate.

Subject First Name is required
Subject Middle Name is required
Subject Last Name is required

Subject Gender is required
Shipping & Contact Information
Home Address
Invalid Home Address Type

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

Home Address Line 1 is required
Invalid City selection
Invalid State selection
International State/Province is required
Invalid APO/FPO selection
Zip/Postal Code is required
Invalid Country
Shipping Address
Invalid Shipping Address Type

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.

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

First Name is required
Last Name is required
Shipping Address Line 1 is required
Unable to ship to PO Box if UPS is selected as a shipping option
Unable to ship to PO Box if UPS is selected as a shipping option
Invalid City selection
Invalid State selection
International State/Province is required
Invalid APO/FPO selection
Zip/Postal Code is required
Invalid Country

Telephone & Email Address of the Requestor:  ID requirements and other important information will be emailed to you. An incorrect email address will result in delays.

Invalid phone number
Email Address is required
Confirmation Email Address is required and must match Email Address
Certified Copy of Connecticut
$35 OFF each additional official copy
Number of Copies is required
Processing Service is required

Important:  Does not include ID verification and delivery times.

Processing and Delivery is required

Important:  UPS to Alaska, Hawaii or Puerto Rico is up to $27.50. UPS Canada/Mexico is up to $28.00. UPS to all international locations is up to $49.50. Delivery method and price are subject to change based on delivery location

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

$32.95 per certificate ($20.00 each additional certificate)

Important:  State and Agency Fees are subject to change. Delivery Time Frames are not guaranteed and delivery to remote areas may take longer

Billing Details
Billing Address

County Requirements:  For the selected County, the Billing Address must match the Home Address

Invalid Billing Address Type

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

First Name is required
Last Name is required
Billing Address Line 1 is required
Invalid City selection
Invalid State selection
International State/Province is required
Invalid APO/FPO selection
Zip/Postal Code is required
Invalid Country
Payment Information
Credit Card Number is required
Credit card icon Credit card icon Credit card icon Credit card icon Credit card icon Credit card icon
Credit Card Expiration is required
Credit Card Security Code is required. For American Express cards, this is a 4-digit code found on the front of the card.
Important:  This is a 3-digit code on the back for Visa, Mastercard, and Discover, and a 4-digit code on the front for American Express cards.
Order Summary
Connecticut
Qty: Not specified
Online Processing Fee:
Not specified
Qualifying Review:
Not specified
American Express/Discover Discount
Not specified
Connecticut State & Agency Fee:
Not specified
Shipping Fee:
Not specified
IMPORTANT:  You will be charged $(not specified) when you submit your order and the remainder will be charged when the order is processed by the state issuing agency.
IMPORTANT:  The total price will be calculated and shown once all required fields on this order form have been completed.
Verify Order

1. I understand US Vital Records (USVR) offers professional advice and provides support to help eliminate errors when applying for vital certificates. USVR assists in verifying that applications are accurate to avoid delays in processing. USVR is not operated, licensed, or affiliated with any government agency.

2. 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.

3. I accept the Terms of Service, including the refund and cancellation policies.

Type your full name in the field below. Typing your full name constitutes a signature and an agreement that you have read and agreed to all the provisions above. It additionally affirms that all information provided on this order form is complete and accurate and that you are an authorized individual to obtain the requested vital certificate.

Signature is required
Possible Issues Detected

Hi there! You are seeing this message because our system detected one or more potential issues with your submission. Please review each issue below and make any necessary corrections. Once you are satisfied with your submission, you may continue by submitting the form again.

Before submitting your order, please take a moment to review your information.
Incorrect information provided will lead to delays and could possibly cancel your order.