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Death Without Official Michigan Record A Michigan Genealogical Council Project DWR - MGC, P.O. Box 80953, Lansing, MI 48908-0953
REGISTRATION FORM Please print this form, print or type responses, and mail two copies with proofs to the address above. This Michigan Genealogical Council Project is accepting registrations for persons who died in or before 1900, and left no Michigan official record. Persons may be registered who lived in Michigan, had lived in Michigan and died elsewhere, died in Michigan and were not usual Michigan residents, or were children of lifetime Michigan residents.
	AFFIDAVIT: To the best of my knowledge there is no official State or County of Michigan death record for the person I am registering. I release all rights to these materials to the Michigan Genealogical Council for archiving, creation of a database, and sale of copies (this in no way affects my personal use of said material.) I understand that depositing any number of "Proof of Death" records entitles me to receive an equal number of other "Proof of Death" records from the database free. SIGNATURE: _________________________________________
All events must have occurred on or before 1900. Use the format "9 September 1880" for all dates.
	If there is an official death record elsewhere (outside of Michigan), show the place it is registered and, if possible, provide a copy of the record.
	No record: ____ Record and location: _____________________________________________________
1.	Decedant's name, with maiden name for married women.
	Full name: ________________________________	Maiden name: _________________________
2.	Decedant's birth and marriage dates and places, if available. Give location, city or township, county, state, country, or any appropriate geographical description.
	Birth date: ________________________________	Place: _______________________________
	Marriage date: _____________________________	Place: _______________________________
3.	Decedant's death date and place. Give location, city or township, county, state, country, or any appropriate geographical description.
	Death date: ________________________________	Place: _______________________________
4.	Decedant's burial date and place. Give location, city or township, county, state, country, or any appropriate geographical description.
	Burial date: _______________________________	Place: _______________________________
5.	Sources of information for the above. Refer to list of primary and secondary sources. Copies of sources must be attached to this registration form.
6.	Parental family of decedant with sources.	A family group sheet may be attached.
7.	Decedant's family with spouse, children, and sources.	A family group sheet may be attached.
All proofs must be photocopies of original records. No transcriptions of records will be accepted. Photographs of tombstones are acceptable. Send two copies of this completed form with all proofs. Do not send original records!

This page is provided as a public service by the Genealogical Society of Washtenaw County, Michigan, Inc.
http://www.hvcn.org/info/gswc/mideath.htm
Revised 15 October 2007.