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Death Certificate Application form - BDM2

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As at 01/07/2019 Page 1 of 3 Death Certificate Application FORM (Western Australia ONLY) Payment details over the page you MUST return pages 1 and 2 if applying via mail Identification and Certificate Access Requirements See page 2 or visit Processing Times for Mailed Certificate Applications Tax Receipt required Standard Please allow up to 2 working days plus regular postal delivery time * Priority Processed within 24 hours of receipt plus priority postal delivery time Death DETAILS REQUIRED Please PRINT clearly ABN: 70 598 519 443 Surname Given name(s) Date of Death Day Month Year Age at Death Male Female / / Place of Death in Western Australia Suburb / Town Parent s full name Given name(s) Surname Maiden Surname (if applicable) Parent s full name Given name(s) Surname Maiden Surname

As at 20/6/2018 Page 2 of 3 Registry of Births Deaths and Marriages, Western Australia BDM2 DEATH CERTIFICATE APPLICATION INSTRUCTIONS PAYMENT DETAILS If applying for more than one certificate only complete payment details on one form

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