Town Clerk
Registrar of Vital Statistics
42C North Street
Goshen, CT 06756
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Note: Legal fee for vital records copies is $20.00 for each certified copy
Number of copies______________ X $20.00 per copy Total $__________**
APPLICATION FOR A COPY OF DEATH CERTIFICATE
Full name of Deceased: _________________________________________________________
Date of Death : _______________________________
Place of Death: _______________________________
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Person requesting this information:
Full name: ________________________________________________________
Address: ________________________________________________________
City: ______________________________State__________Zip__________
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*Please make checks payable to the Goshen Town Clerk
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