The Wisconsin F 05297 form is a fax application used to request a death certificate in the state of Wisconsin. This form collects necessary information to process your application and payment for certified or uncertified copies of a death certificate. If you need to obtain a death certificate, fill out the form by clicking the button below.
The Wisconsin F 05297 form is an essential document for anyone seeking to obtain a death certificate in the state of Wisconsin. This fax application allows individuals to request either a certified or uncertified copy of a death certificate, depending on their relationship to the deceased. A certified copy is often necessary for legal purposes, such as settling an estate or claiming insurance benefits, while an uncertified copy may suffice for personal records. The form requires specific information, including the applicant's relationship to the decedent, and it mandates the inclusion of valid identification to ensure the request is legitimate. Fees are associated with the application, and applicants must be aware of the penalties for providing false information. The process is designed to be straightforward, yet it emphasizes the importance of accurate and truthful submissions. Understanding the requirements and implications of the Wisconsin F 05297 form is crucial for those navigating the sensitive task of obtaining a death certificate.
What is the difference between a “certified” and an “uncertified” copy of a death certificate?
A certified copy of a death certificate is an official document issued by the State Vital Records Office. It includes a raised seal, the signature of the State Registrar, and is printed on security paper. This type of copy is often required for legal purposes, such as settling an estate or claiming insurance benefits. Access to certified copies is restricted to individuals with a “direct and tangible interest,” which includes immediate family members and legal guardians.
In contrast, an uncertified copy contains the same information but lacks the official features. It cannot be used for legal purposes. Anyone can request an uncertified copy, but it will not be valid for claims or legal identification.
How long will it take to process my request?
The processing time for death certificate requests varies based on the method of application. If you apply by fax and request regular mail shipping, it may take up to 5 business days, plus additional time for mail delivery. If you opt for UPS shipping, the request is typically completed and shipped within two business days. It is important to note that copies of death certificates are available no less than 3 weeks from the date of death.
What identification is required when applying for a certified or uncertified copy of a death certificate?
When applying for either type of death certificate, you must submit a photocopy of your current identification. At least one form of ID must display your current name and address. Acceptable forms of ID include a Wisconsin driver’s license, a government-issued employee ID, or a US passport. Alternatively, you may provide two forms of ID, such as a recent utility bill or a signed lease. Expired documents will not be accepted, so ensure that your ID is current.
What are the fees associated with obtaining a death certificate?
The fees for obtaining a death certificate are outlined in the application form. A search fee of $20 is required, which includes one copy if the record is found. Additional copies can be requested for $3 each. If you require expedited service, an additional fee of $20 applies. There is also a credit card processing fee of $6. Shipping costs vary, with regular mail being free and UPS next day delivery costing $19. Remember, fees are non-refundable if no record is found, and cancellations are not accepted.
1. Accurate Information is Essential: Complete all sections of the Wisconsin F 05297 form carefully. Incomplete or incorrect information may delay processing or result in denial of your application.
2. Relationship Verification: Applicants must indicate their relationship to the deceased. Only immediate family members or authorized representatives can request certified copies. Legal proof may be required for certain relationships.
3. Fees are Non-Refundable: The search fee is mandatory and non-refundable, even if no record is found. Be aware of additional fees for extra copies or expedited service.
4. Identification Requirements: A valid photo ID must accompany the application. Acceptable forms include a Wisconsin driver’s license or a U.S. passport. Ensure that at least one ID shows your current name and address.
5. Processing Time Varies: Expect a minimum of three weeks for processing. Requests sent via fax for regular mail may take up to five business days, while UPS requests are typically completed within two business days.
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In reality, a photocopy of the applicant's current ID is required. This ensures that the person requesting the death certificate is authorized to do so.
Only individuals with a "direct and tangible interest," such as immediate family members or legal guardians, can receive a certified copy. Others may only obtain an uncertified copy.
The processing time varies depending on the shipping method chosen. Regular mail may take up to 5 business days, while UPS shipping usually completes within two business days.
The form explicitly states that credit card information is necessary to process the application and payment for copies of the death certificate.
This is incorrect. An uncertified copy cannot be used for legal identity or benefit purposes, such as claiming insurance benefits.
Providing false information is a serious offense. It is classified as a Class I felony, which can result in significant fines or imprisonment.
Applicants must indicate their relationship to the person named on the death certificate. This information is crucial for determining eligibility to receive a certified copy.
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