Row Officers

Coroner's Office

Legal Purposes / Claims Processing (Certified Copies)

Print This Form

Steps For Filling Out the Form:
1. Fill out form online
2. Print entire form
3. Fill in the blanks
4. Include any necessary attachments
5. Mail to the address at the bottom of this page

**Please note:

• This form is for Bucks County Cases only.
• Please call the Coroner's office to check availability of reports before submitting form.

Part 1: Legal Purposes / Claims Processing (Certified Copies)

Firm/Company Name:
Date:
Firm/Company Address1:
Address2:
City:
State:
Zip:
Firm/Company Telephone Number: (with area code:)	Extension:
Contacts Name:
Title:
Reason For Records	Legal Claims Processing Other If other, please specify
Reason For Records	Informational Legal Purposes Medical Purposes Other If other, please specify
Part 2: Decedent Information
Name of Decedent:
Age:
Date of Birth:
Date of Death:
Place of Death: (Name of Hospital)
Hospital Address:
City:
State:
Zip:
Cause of Death
Records Requested	Coroner's Report Autoposy Report Toxicology Report Photos If other, please specify
Fee For Service:
	$50.00 - Coroner's Report
	$100.00 - Autopsy Report
	$50.00 - Toxicology Report
	$25.00 - Photographs (per photo) call office for availability and number of photos taken. Check for fees must be made payable to: Bucks County Commissioners
* Check for fees must be enclosed and made payable to : Bucks County Coroner's Office
I understand that by signing my name to this application for record or reports, generated by the Bucks County Coroner's Office that the information in which I furnished is correct and truthful to the best of my knowledge, under penalty of law.
Signature:	___________________________________
Printed Name:	___________________________________
Date Signed:	___________________________________
NOTE: Coroner's Reports prior to 1997 are on microfilm and take approximately one week to retrieve and mail. DEATH CERTIFICATES are NOT part of the Coroner's Report; if you need a copy of a death certificate, please contact the Bureau of Vital Statistics at: 1-800-842-5040 ext. 3005

 

Steps For Filling Out the Form:
1. Fill out form online
2. Print entire form
3. Fill in the blanks
4. Include any necessary attachments
5. Mail to the address below