Form ACR 406 is the application the Riverside County Assessor-County Clerk-Recorder uses to issue a certified copy of a death record or to search for one. People who need a death certificate, whether an authorized copy or an informational copy, complete it with the details of the deceased and the reason they qualify. It covers death records only, not a Riverside County birth certificate. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the county publishes the original PDF at the official link below.
Last updated
What is ACR 406?
Form ACR 406, Certified Copy or Search of a Death Record, is the application to the Riverside County Assessor-County Clerk-Recorder for a certified copy of a death record, or for a search that produces a Certificate of No Record if no record is found.
The form is printed as "Application for Certified Copy or Search of a Death Record." You choose between two kinds of copy. An authorized certified copy may be required to obtain death benefits, claim insurance proceeds, notify Social Security and obtain other services tied to a person's identity. An informational certified copy is imprinted across its face with the words "INFORMATIONAL, NOT A VALID DOCUMENT TO ESTABLISH IDENTITY." California Health and Safety Code Section 103526 restricts who may receive an authorized copy, which is why the form has a list of eligible applicants and a sworn statement.
Riverside County holds only records of deaths that occurred in Riverside County. If no record is found, the fee printed on the form is retained for the search under Health and Safety Code 103650, and a Certificate of No Record is issued.
This is a death-record application. It is not the form for a Riverside County birth certificate, and the form does not cover birth records.
Who needs to file ACR 406?
Anyone who needs a certified copy of a death record for a death that occurred in Riverside County, or a search for one, uses this form.
For an authorized copy you must check one of the boxes in section 3 of the form:
- the parent or legal guardian of the person on the death record;
- a child, grandparent, grandchild, sibling, spouse or domestic partner of that person;
- a member or representative of a government agency conducting official business (a company representing a government agency must provide the agency's authorization);
- next of kin or an appointed conservator, as specified in paragraphs (6), (7) and (8) of subdivision (a) of Section 7100;
- a person with a court order to obtain the record;
- an attorney representing the person or the person's estate, or a person or agency appointed by a court to act for them (when ordering under a power of attorney, include a copy of it);
- an agent or employee of a funeral establishment ordering on behalf of an individual specified in paragraphs (1) to (5) of subdivision (a) of Section 7100.
If you are not one of these people, you receive an informational copy and skip the sworn statement. If the death did not occur in Riverside County, this county cannot help: the instructions send you to the county where the death occurred or to the Department of Health Services, Office of Vital Records.
When to file ACR 406
You file Form ACR 406 when you need a certified copy of a Riverside County death record or a search for one; the form prints no deadline of its own. An authorized copy may be required to obtain death benefits, claim insurance proceeds or notify Social Security, so apply when one of those steps is waiting on the document. If you are ordering by mail and want an authorized copy, allow time to have the sworn statement notarized before you send the application. The form gives no processing time.
Documents you need
- A governmental issued picture ID, required if you order in person; have it ready when you apply.
- A check payable to Riverside County Recorder, when you apply by mail.
- The notarized Certificate of Acknowledgment on the back of the form, for an authorized copy ordered by mail; law enforcement members and government agency representatives on official business are exempt.
- A copy of the power of attorney, if you request a certified copy under a power of attorney as an attorney or agent.
- Authorization from the government agency, if a company is requesting the record on behalf of a government agency.
How to fill out ACR 406
Enter the death record information
In section 1, enter the name of the deceased (first, middle, last), the date of death, the date of birth, the city of death and the number of copies. Give all the information you have to identify the record.
Confirm the death was in Riverside County
Riverside County only has records of deaths that occurred in Riverside County. For any other death, contact the county where it occurred or the Department of Health Services, Office of Vital Records.
Choose authorized or informational copy
In section 2, check I am requesting an AUTHORIZED copy or I am requesting an INFORMATIONAL copy. If you choose informational, skip to section 4.
Check your eligibility box
For an authorized copy, check the one box in section 3 that describes you, such as a parent, a child or spouse, a government representative or an attorney. Attach a copy of the power of attorney if you order under one.
Complete your requester details
In section 4, enter your name, street address, city/province, state/country, ZIP and phone number. If someone else will receive the copies, add that person's name and mailing address in the Mail/Issue To column.
Complete the sworn statement
For an authorized copy, print your full name in section 5 and enter the date (mm/dd/ccyy) and the city and state where you sign. Sign the statement; in person, sign in front of the Clerk, and by mail, sign in front of a notary.
Skip the office-use area
Leave the section marked for office use only blank. It holds the receipt, payment and search information the county completes.
Review, download and sign the PDF
Check each section against your records and make sure you use black or blue ink for any handwritten entries. Download or print the completed PDF from FillingPDF, then assemble the package described under How to submit.
How to submit ACR 406
You can submit Form ACR 406 by mail or in person.
- By mail: send the application and a check payable to Riverside County Recorder to P.O. Box 751, Riverside, CA 92502-0751. For an authorized copy, the sworn statement must be completed in front of a notary public, using the Certificate of Acknowledgment on the back of the form. For an informational copy, neither the section 5 sworn statement nor the notarized statement is required. When you send several requests together, every request needs the completed sworn statement, but only one needs the notary statement. Members of law enforcement agencies and representatives of state or local government agencies conducting official business, as provided by law, do not need the notarized statement.
- In person: bring a governmental issued picture ID. When ordering in person you must sign the sworn statement in front of the Clerk.
A fee applies and is printed on the form; the instructions do not list other payment amounts. If you ask for a death record from another county, contact that county or the Department of Health Services, Office of Vital Records-M.S. 5103, P.O. Box 997410, Sacramento, CA 95899-7410, phone (916) 445-2684. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Requesting a death record that is not from Riverside County; the county only has records of deaths that occurred there.
- Asking for an authorized copy without checking one of the eligibility boxes in section 3.
- Mailing an authorized-copy request without having the sworn statement completed in front of a notary public.
- Signing the sworn statement in advance when ordering in person; you must sign in front of the Clerk.
- Leaving out a copy of the power of attorney when ordering under one.
- Making the check payable to anyone other than Riverside County Recorder.
- Filling in the form in pencil or another color; the instructions say to print in black or blue ink.
- Expecting an informational copy to prove identity; it is imprinted "INFORMATIONAL, NOT A VALID DOCUMENT TO ESTABLISH IDENTITY."
- Writing in the office-use area at the bottom of the form.
Frequently asked questions
Can I use Form ACR 406 to get a Riverside County birth certificate?
No. Form ACR 406 is the application for a certified copy or search of a death record only. It is issued by the Riverside County Assessor-County Clerk-Recorder and covers deaths that occurred in Riverside County; it does not request birth records.
Who can get an authorized certified copy of a death record?
Only the people listed in section 3 of the form: a parent or legal guardian, a child, grandparent, grandchild, sibling, spouse or domestic partner, certain government representatives, next of kin or a conservator, a person with a court order, an attorney, or a funeral establishment agent.
What is the difference between an authorized and an informational copy?
An authorized copy can be used for identity-related purposes, such as death benefits, insurance claims and notifying Social Security. An informational copy is imprinted "INFORMATIONAL, NOT A VALID DOCUMENT TO ESTABLISH IDENTITY" and needs no sworn statement.
Do I need a notary to request a death certificate by mail?
Yes, for an authorized copy: the sworn statement must be completed in front of a notary public. An informational copy does not need it, and law enforcement members and government agency representatives on official business are exempt. With multiple requests, only one needs the notary statement.
Where do I mail Form ACR 406?
Send the application and a check payable to Riverside County Recorder to P.O. Box 751, Riverside, CA 92502-0751. Use that address for requests made by mail; the form says to sign in front of the Clerk when ordering in person.
What happens if no death record is found?
The fee is retained for the search under Health and Safety Code 103650, and a Certificate of No Record is issued. The form prints the fee amount; confirm it with the county before sending payment.
What if the death happened outside Riverside County?
Contact the county where the death occurred, or the Department of Health Services, Office of Vital Records-M.S. 5103, P.O. Box 997410, Sacramento, CA 95899-7410, phone (916) 445-2684. Riverside County only has records of deaths that occurred in the county.
Can I fill out Form ACR 406 online on FillingPDF?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF does not submit the application or notarize it; you mail it or bring it in person following the county's instructions.
Ready to fill out ACR 406?
Fill out ACR 406 now