Again, make your own copies and keep them on file for future use..........Cynthia General Services Center Reference/Reseach Drawer 33 Monteplier, Vt 05633-7601 tel: 802-828-3286 fax: 802-828-3710 APPLICATION FOR SEARCH OF VERMONT DEATH RECORD 1. print or type all information clearly 2. enclose check, money order, or Visa/Mastercard # (make check payable to General Services) 3. mail to above address. You MUST enclose a self addressed stamped envelope 4. price is $7.00 per person per time period searched 5. check off time period to search below: 1760-1870____ 1871-1908___ 1909-1941___ 1942-1954___ 1955-1979___ 1980__ 1981___ 1982___ 1983___ 1984____ 1985____ 1986____ - --------------------------------------------------------------- 1. Name of person at death_______________________________ 2. approximate date of death_________________________ 3. spouse of individual_____________________________-- 4. your relationship to person being searched__________________________- 5. other pertinent information of person________________________________- 6, this document is needed for what purpose ________________________________ - -------------------------------------------------------------------------- ---------- YOUR name_____________________________ Street__________________________________ town_______________________ State______________ Zip code_______________ check enclosed $___________ money order $______________ visa /mastercard #__________-__________-___________-______________ expiration date of visa/Mc ____________________ there is a $5.00 fee for using Visa or Mastercard - -------------------------------------------------------------------------- - ---------------------------------------------- researcher__________________________ date______________________