Amend Cause of Death on a Wisconsin Death Certificate

It is the petitioning party’s responsibility to contact the Wisconsin Office of Vital Records regarding amending cause of death on a Wisconsin death certificate.

The state registrar may request the petitioning party to provide the following to their office:

1. Statement indicating why the cause of death is incorrect and what the correct information should be.
2. Current certified copy of death certificate that includes the incorrect information
   • Application to obtain a certified copy of death certificate is available at the Wisconsin Department of Health Services or at the Ozaukee County Register of Deeds.
3. Evidence that the current death record is incorrect. Evidence includes:
   • A current certified copy of a vital record verifying the correct name of the decedent or his or her parents or spouse
   • Notarized affidavit from the funeral director explaining the error made
   • Notarized statement from a health care facility staff person or the county coroner/medical examiner verifying the correct date of death
   • If cause of death (either the current cause listed or the change being sought) involves a coroner/medical examiner case as defined in Wis. Stats. § 979.01, the Court will need a statement from the coroner or medical examiner of the county with jurisdiction to investigate the case.

The Wisconsin Office of Vital Records reviews the documentation provided by the petitioning party and sends an amendment packet to the petitioning party if a court order is required to amend the cause of death.

Upon receiving the amendment packet from the Wisconsin Office of Vital Records, an action can be filed with the Ozaukee County Clerk of Courts upon completing the necessary forms and paying the required filing fee.

Forms/Documents Required to Commence an Action

1. Form F-05054 – Court Order to Amend Cause of Death on a Wisconsin Death Certificate

• This document is included in the amendment packet from the Wisconsin Office of Vital Records. This form is not available at the Clerk of Courts Office.
• Petitioning party is to complete the pertinent sections.
• This form cannot contain erasures, cross-outs, write-overs, correction tape or correction fluid.

2. Petition indicating why the cause of death is incorrect and what the correct information should be

3. Current certified copy of death certificate

4. Any evidence which verifies the current death certificate is incorrect

Filing Instructions

The petitioning party is to bring Form F-05054- Court Order to Amend Cause of Death on a Wisconsin Death Certificate along with the current certified copy of the death certificate, statement, and evidence to the Ozaukee County Clerk of Courts

1. A Filing fee of $164.50 must be paid.
   • Cash, checks, money orders, debit and credit cards are accepted for Clerk of Courts fees only. An additional service fee is charged when paying with a debit or credit card.
2. A court case number and circuit court judge are assigned to the case.
3. The Clerk of Courts Office will forward all documents and supporting evidence to a Circuit Court Judge for review.
   • If the Petition is approved, the Court will sign the Court Order to Amend Cause of Death on a Wisconsin Death Certificate.
   • If the Petition is not approved, the Court may schedule a court hearing.

Recording an Amended Death Certificate

Upon the court official granting the request to amend cause of death and signing the Court Order to Amend Cause of Death on a Wisconsin Death Certificate, the Ozaukee Clerk of Courts office will apply a seal to the document. The Clerk of Courts Office will mail the Court Order to Amend Cause of Death on a Wisconsin Death Certificate to the Wisconsin Office of Vital Records with the petition party’s check/money order to cover the fees and for any additional copies of the amended death certificate.

Vital Records Fees:

• $10.00 vital records fee
• $20.00 for a certified copy of the amended death certificate
• $3.00 or each additional copy of the amended death certificate issued at the same time as the first

Checks/money orders are to be made payable to State of Wisconsin Vital Records. Cash, debit, or credit cards are NOT accepted for vital records fees.

An authenticated copy of the Court Order to Amend Cause of Death on a Wisconsin Death Certificate, Statement, and supporting evidence will be returned to the petitioning party by the Ozaukee County Clerk of Courts via first class mail.

It may take 3-4 weeks for the petitioning party to receive the requested copy(s) of the amended death certificate from the Wisconsin Office of Vital Records.