The Wisconsin F 05297 form is a critical document for anyone needing to obtain a death certificate in the state of Wisconsin. Outlined by the Department of Health Services, this fax application enables individuals to request certified or uncertified copies of death certificates, contingent upon their relationship to the deceased and the specified purpose for the request. The process is delineated with stringent requirements for personal identification and proof of entitlement, ensuring that records are released responsibly and respectfully.
Understanding the intricacies of obtaining a death certificate in Wisconsin requires familiarity with the F-05297 form, a crucial document facilitated by the Department of Health Services under the State of Wisconsin's Division of Public Health. This form plays a pivotal role for individuals seeking to obtain a Wisconsin death certificate, whether for legal, personal, or financial reasons. The form explicitly outlines the process, including the detailed information and specific fees required for the request. By outlining who can request a certified copy—ranging from immediate family members to legal guardians, and detailing the difference between certified and uncertified copies, the F-05297 form serves as a comprehensive guide. It highlights penalties for false applications, ensuring the integrity of the process. Additionally, it explains the fees involved, including search and expedited service fees, and the payment process, including credit card information for processing. Moreover, the form underlines the importance of providing accurate ship-to information and stipulates the required identification for processing the request, offering clarity on how to expedite the request through fax and the kinds of certificates available, varying from fact of death to extended fact of death certificates. This facilitates a better understanding of the timeframe for processing requests, based on the chosen method of submission and delivery, ensuring individuals are informed every step of the way.
DEPARTMENT OF HEALTH SERVICES
STATE OF WISCONSIN
Division of Public Health
Chapter 69.21(1a), (2b), Wis. Stats.
F-05297 (Rev. 06/13)
Page 1 of 2
FAX APPLICATION FOR A WISCONSIN DEATH CERTIFICATE
Personally identifying information requested on this form, including credit card information and your signature, will be used to process your application and payment for the requested copies. Failure to supply this information may result in denial of your request for copies of any Wisconsin Death Certificate.
Your credit card number and expiration date are required. The credit card number and expiration date will only be used to process payment for the fees specified in SECTION III – FEES below on this FAX Application for a Wisconsin Death Certificate.
PENALTIES: Any person who willfully and knowingly makes a false application for a death certificate is guilty of a Class I felony [a fine of not more than $10,000 or imprisonment of not more than 3 years and 6 months, or both, per s. 69.24(1)]. Any person who willfully and knowingly obtains a death certificate for fraudulent purposes is guilty of a Class I felony [a fine of not more than $10,000 or imprisonment of not more than 3 years and 6 months, or both, per s. 69.24(1), Wis. Stats.].
INSTRUCTIONS: Please complete this form and FAX to 608-255-2035. All FAX applications are charged an expedited service fee. See Page 2 of this form for valid photo ID requirements for processing this application.
SECTION I - SHIP TO INFORMATION
(Print or type.) (You must complete this section for application to be processed.)
1. FULL NAME (First , Middle, Last )
DAYTIME TELEPHONE NUMBER
(
)
3.STREET ADDRESS or P.O. BOX (You must provide a street address if you are requesting shipping by UPS.)
APT. NUMBER
4. CITY
5. STATE
6. ZIP CODE
SECTION II - APPLICANT'S RELATIONSHIP TO THE PERSON NAMED ON THE DEATH CERTIFICATE (Decedent) (CHECK ONE)
A. I am a member of the immediate family of the person named on the death certificate. (Only those listed below qualify as immediate family.) NOTE: Grandchildren, step-parents, step-children and step-brothers/step-sisters may only obtain certified copies as section II, categories C – E.
CHECK ONE.
Parent (whose name is on the death certificate and whose parental rights have not been terminated)
B.
Current Spouse
Brother / Sister
Grandparent
Child
Current Domestic Partner (registered in the Wis. Vital Records System)
I am the legal custodian or guardian of the person named on the death certificate. (Legal proof is required. See item 1 on page 2.)
C. I am a representative, authorized in writing, by any of the above checkboxes (categories A and B). (The written and notarized authorization must
be attached to this application. See item 1 on page 2.)
Specify the person you represent: _______________________________________________________________________________________________
D.I can demonstrate that the information from the death certificate is necessary for the determination or protection of a personal or property right for myself/my client/my agency. (Proof is required.)
Specify your interest: _________________________________________________________________________________________________________
E. None of the above. I am requesting an uncertified copy. Copy will not be valid for legal identity or benefit purposes. See Item 1 and 2 on page 2.
I hereby attest that the information provided on this application is correct to the best of my knowledge and belief and that I am entitled to copies of the requested death certificate in accordance with the categories listed above.
SIGNATURE – Applicant (person named in section I, who is completing this application)
Date Signed ( Month / Day / Year )
SECTION III - FEES READ INSTRUCTIONS ON PAGE 2 OF THIS FORM BEFORE COMPLETING THIS SECTION.
Mandatory fees are already filled in. Fill in additional fees for extra copies or for UPS delivery, if applicable.
FEES ARE NOT REFUNDABLE IF NO RECORD IS FOUND. CANCELLATIONS ARE NOT ACCEPTED.
1.
Search Fee
(includes one copy if found) ……………………...……
$ 20.00
___20.00 __
Fact of Death (without cause of death) or
Extended Fact of Death (with cause of death)
2.
Additional copies of the same certificate issued at the same time as the first copy
Fact of Death Certificate (without cause of death) ……………………….……... ________________________ X
$
3.00
__________
number of additional copies
Extended Fact of Death Certificate (with cause of death) …………………........ ________________________ X $
3.
Expedited Service Fee ………..……….……………………………………………………………................………………. $
20.00
___20.00___
4.
Credit Card Processing Fee ……………………………………………………………………………...............…………..
6.00
____6.00___
5.
Shipping
Regular Mail - No additional cost; mailed within five business days ………...............………………
0.00
UPS Next Day - $19.00 in the continental U.S.A.; shipped within two business days .............…....
19.00
UPS packages require a signature for delivery.
NOTE: If no shipping box is checked, the copy will be sent by regular mail.
TOTAL
SECTION IV - CREDIT CARD INFORMATION We accept Visa, MasterCard, American Express, or Discover.
CREDIT CARD NUMBER ____________________________________________________________ EXPIRATION DATE ________________________
SIGNATURE - Credit Card Holder _________________________________________________ DATE SIGNED____________________________
SECTION V - DEATH CERTIFICATE INFORMATION
FULL NAME OF DECEDENT (First, Middle, Last)
DATE OF DEATH (Month / Day / Year )
PLACE OF DEATH - City, Village, or Township *
PLACE OF DEATH - County
AGE or DATE OF BIRTH*
NAME OF SPOUSE * (First, Middle , Last )
DECEDENT'S SOCIAL SECURITY NUMBER *
*The fields marked with an asterisk (*) do not have to be completed. The information is helpful but not required.
VITAL RECORDS OFFICE USE ONLY
Certificate Number
Page 2 of 2
1.What is the difference between a “certified” and an “uncertified” copy of a death certificate?
A certified copy of a death certificate issued by the State Vital Records Office will have a raised seal, will show the signature of the State Registrar, and will be printed on security paper. A certified copy may be required to settle an estate or to claim insurance benefits.
State law restricts who may obtain a certified copy of a death certificate. A certified copy can only be issued to those people with a “direct and tangible interest” (section II, categories A – D) which means the following people:
An immediate family member defined as a parent (whose name is on the death certificate and whose parental rights have not been terminated), current spouse, brother, sister, grandparent, child, or current domestic partner (Declaration of Domestic Partnership registered in the Wis. Vital Records System under Chapter 770, Wis. Stats.) of the subject of the record (section II, category A).
NOTE: Grandchildren, step-parents, step-children, step-brothers and step-sisters can only obtain certified copies as section II, categories B - D.
The legal custodian or guardian of the person named on the death certificate. Legal proof, e.g., a court order of custody or guardianship, is required (section II, category B).
A person authorized in writing by one of the above. A written and notarized authorization must be attached to this application and the authorization must clearly state the relationship of the authorizing party to the subject of the record (section II, category C).
A person who can demonstrate that the birth certificate is required to determine or to protect a personal or property right (section II, category D) Proof is required.
If you do not meet one of the above criteria, you cannot receive a certified copy of a death certificate.
An uncertified copy will contain the same information as a certified copy but it is not acceptable for legal purposes, such as claiming insurance benefits (section II, category E).
For pre-2003 death certificates, an uncertified copy of a death certificate will contain the same information as a certified copy.
For death certificates 2003 to the present, only persons named in categories A – D on the previous page may have access to information that includes cause of death.
PRE-2003 DEATH CERTIFICATES
2003 TO PRESENT DEATH CERTIFICATES
CERTIFIED COPY
TYPE OF CERTIFICATE AVAILABLE
Extended Fact of Death *
Fact of Death **
A certified copy has a raised seal, will show the signature of the
TYPE OF RECIPIENT
state Registrar, and will be printed on security paper. It can be
used for legal purposes, such as settling an estate or claiming
Must have a “direct and tangible interest”
insurance benefits.
UNCERTIFIED COPY
An uncertified copy can NOT be used for legal purposes.
Anyone
*
Extended Fact of Death Certificate. Cause of death included; can be used for insurance benefit claims
**
Fact of Death Certificate. No cause of death included; can be used for banking and most other financial transactions
2.How long will it take to process my request?
Copies of death certificates are available from the State Vital Records Office no less than 3 weeks from the date of the death.
Applying by Fax requesting Regular Mail Shipping:
Requests for copies of death certificates may take up to 5 business days plus mail time to complete.
Applying by Fax requesting UPS Shipping:
Requests for copies of death certificates are usually completed and shipped within two business days.
3.What identification is required when applying for a certified or uncertified copy of a death certificate?
A photocopy of the applicant’s current ID as listed below must be submitted with all fax applications.
At least one form of ID must show your current name and current address. Expired cards or documents will not be accepted.
The acceptable forms of identification are:
One of these:
OR
Two of these:
Wisconsin driver’s license
Government-issued employee ID
Major Credit Card
Wisconsin photo ID
card or badge with photo
Health Insurance Card
Out-of-state driver’s license or photo ID card
US Passport
Recent dated, signed lease
Check or bank book
Recent utility bill or traffic
ticket
If you have questions regarding this form, please call 608-266-1373
or visit our website at http://www.dhs.wisconsin.gov/vitalrecords
When you need to request a Wisconsin Death Certificate, the process involves submitting specific information to ensure your application is processed efficiently. The sequence of steps to complete the F 05297 form is straightforward but must be followed carefully to avoid delays. After filling out the form, the next phase involves sending it with the required fees and identification to the designated fax number. It's important to remember that providing accurate information is crucial to avoid processing errors or legal issues.
After submitting your application, it will be processed based on the method of delivery you selected. Regular mail shipments are completed within five business days, while UPS requests are typically expedited and shipped within two business days. Ensure you have provided a valid form of identification to meet the requirements for processing your request. Should you encounter any issues or have questions regarding your application, assistance is available through the contact information provided on the form..
What is the difference between a "certified" and an "uncertified" copy of a death certificate?
A certified copy of a death certificate comes with a raised seal and the signature of the State Registrar, printed on security paper, signifying its authenticity for official purposes like settling an estate or claiming insurance benefits. State laws limit access to certified copies to those with a "direct and tangible interest", primarily immediate family members, legal custodians or guardians, persons authorized in writing by immediate family members, or someone requiring the death certificate to determine or protect a personal or property right. Conversely, an uncertified copy contains the same information but lacks the official seals and signatures, rendering it unsuitable for legal uses.
How long will it take to process my request for a copy of a death certificate?
Processing times for death certificate requests vary based on the method of application and shipping. For fax applications opting for regular mail, expect the process to take up to 5 business days plus mail time. If choosing UPS shipping, the processing is faster, usually completed and shipped within two business days. Remember, it generally takes at least 3 weeks from the date of death for copies to be available from the State Vital Records Office.
What identification is required when applying for a certified or uncertified copy of a death certificate?
When requesting a certified or uncertified copy of a death certificate via fax, submitting a photocopy of your current identification is required. Acceptable forms include a Wisconsin driver’s license, a major credit card, a health insurance card, a U.S. Passport, among others. At least one piece of ID must display the current name and address of the applicant, and expired documents are not accepted. This is to ensure the security and privacy of the vital records process.
Who is considered immediate family for the purposes of obtaining a certified copy of a death certificate?
Immediate family members eligible to receive a certified copy of a death certificate include parents (if their names are on the death certificate and their parental rights have not been terminated), the current spouse, siblings, grandparents, children, and current domestic partners (with a Declaration of Domestic Partnership registered under Wisconsin Statutes Chapter 770). Grandchildren, step-parents, step-children, and step-siblings may only obtain certified copies under specific sections that accommodate broader eligibility criteria, such as legal guardianship or demonstrated need to protect personal or property rights.
What is the penalty for falsely applying for a death certificate?
Willfully and knowingly making a false application for a death certificate in Wisconsin is considered a Class I felony. This serious offense can result in fines of up to $10,000, imprisonment for up to 3 years and 6 months, or both. The same penalties apply to individuals obtaining a death certificate for fraudulent purposes, emphasizing the stringent measures in place to protect individuals' privacy and deter misuse of sensitive information.
Can I cancel my death certificate request once it's been submitted?
No, once your application for a death certificate has been submitted, cancellations are not accepted. This policy is likely due to the processing and administrative efforts initiated upon receiving an application. Fees paid for the search and processing of death certificates are also non-refundable, even if no record is found, further underscoring the importance of ensuring the accuracy and completeness of your application before submission.
When filling out the Wisconsin F 05297 form for a death certificate, many individuals inadvertently make errors that can delay the process or result in denial of the request. Awareness of these common mistakes can help ensure the process is completed more smoothly.
These mistakes can be easily avoided by carefully reviewing the instructions provided on the form and ensuring all required documentation and information are complete and accurate before submission. A precise attention to detail will facilitate a smoother and quicker process in obtaining a death certificate from the Wisconsin Department of Health Services.
When handling the affairs of a loved one who has passed away, it's important to know that the Wisconsin F-05297 form for requesting a death certificate is just one piece of the process. Several other documents and forms might also be necessary, depending on the specific circumstances and what you need to accomplish. Understanding these documents can make managing these tasks more straightforward and less stressful.
Each of these documents has its specific purpose and requirements. It's important to gather and complete these forms accurately to ensure the deceased's estate is managed correctly and in accordance with the law. Remember, you're not alone in this process. Many resources and professionals can provide guidance and support through each step.
The Wisconsin F 05297 form, which is an application for a death certificate, closely resembles the application process for a birth certificate within many states. Like the death certificate application, a birth certificate request form often requires the applicant to provide personal identifying information, reasons for the request, relationship to the person on the certificate, and payment information. Both documents necessitate an understanding of who is legally entitled to obtain a certified copy based on their relationship to the individual on the record or their need to establish legal rights, and both include similar warnings about the misuse of the information for fraudulent purposes.
Another document that shares similarities with the F 05297 form is the application for a marriage certificate. States typically require applicants to provide detailed personal information, fees, and the purpose for which the copy is required. The application process also demands specific identification requirements to prove the applicant's entitlement to the requested document, much like the death certificate application process. This process is designed to protect individuals' privacy and ensure that sensitive information is only released to those with a legitimate claim or familial relationship to the individuals on the record.
The process to request a divorce decree also mirrors the structure and requirements found in the death certificate application. Applicants must provide personal details, specify their relationship to the individuals involved, and often include a fee structure based on the number of copies or the service speed. Like the death certificate application, requesting a divorce decree typically involves stating the purpose of the request, which could range from legal needs to personal records keeping, and demonstrating a direct interest in the document.
Applications for adoption records share a common foundation with the F 05297 form due to the sensitive nature of the information contained within and the restricted access based on the applicant's relationship or legal standing. Though the specifics of the information requested might vary, both forms include stringent ID requirements, fees, and a detailed section on who is eligible to make the request. The focus on protecting the privacy and rights of the individuals mentioned in the documents is a central theme in both application processes.
Finally, the application for a replacement social security card bears resemblance to the Wisconsin death certificate application in terms of identity verification and the protective measures taken to guard against fraudulent requests. Both applications require the requester to provide detailed personal information, proof of identification, and, where applicable, documentation of their relationship to the person whose record is being requested. The emphasis on safeguarding personal information and ensuring that requests are legitimate is paramount in both processes, reflecting the government’s commitment to privacy and security.
When filling out the Wisconsin F 05297 form for a death certificate application, there are several important dos and don'ts to keep in mind to ensure the process goes smoothly. Here are nine tips to help guide you:
Following these guidelines will help ensure your application for a Wisconsin death certificate is processed efficiently and without unnecessary delays. Remember, if you have any questions or need clarification on the process, it's always best to reach out for help.
When dealing with vital records, it's easy to stumble upon misconceptions, especially regarding specific forms like the Wisconsin F 05297 form, used for requesting death certificates. Clarification on common misunderstandings can help streamline the process of obtaining these valuable documents. Here are eight commonly held misconceptions about the F 05297 form:
Understanding these key aspects of the Wisconsin F 05297 form not only clarifies the process but also helps applicants in correctly submitting their request for a death certificate. It's vital to adhere to the stipulated requirements and instructions to ensure a smooth and efficient process.
When dealing with the Wisconsin F-05297 form for requesting a death certificate, it's crucial to understand the document's specifics and the procedures involved. Here are some key points to bear in mind:
Understanding these takeaways will streamline the process of requesting a death certificate from the Wisconsin Department of Health Services. It's always advised to review the form thoroughly and ensure all information is complete and accurate before submission.
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