N.C. OCME Document Request Form (for deaths since 1976)

Document Request Form
Requester's Contact Information
First Name: (Name of person making report request about decedent)	* Required
Last Name:	* Required If you can see this field, leave it blank.
Address Line 1:	* Required
Address Line 2:
Agency:
City:	* Required
State:	* Required
Zip Code:	* Required
Telephone:
Email Address:	* Required Note: Email is required in case we need to contact you about your request.
Information about the Decedent
Decedent's First Name:	* Required
Decedent's Last Name:	* Required
County (or state) of Death:	* Required Note: N.C. counties are listed first, followed by states, and "Unknown".
Date of Death:	* Required (mm/dd/yyyy)
Document(s) Requested
You must choose at least one of the following:	Investigative Report Autopsy Report (May not exist for every case) Toxicology Report
Delivery Preference
Please select one or the other delivery options:	Regular Paper Mail (Postal Service / Snail Mail) Email

N.C. OCME Document Requests (only for deaths since 1975)