You may request as many photo copy certificates as you like.

Please fill out this form, please send the following amounts depending on the size of your order:

1-10 Death Certificates: $7/each

11-20 Death Certificates: $6/each

21+ Death Certificates: $5/each

a self addressed stamped #10 size (like your bills come in) envelope.

Fill in the name, date of death, cert. number (if known) for each one.

Name / County / Date of Death / Cert or page#

1. ______________________________________________________________________________

2. ______________________________________________________________________________

3. ______________________________________________________________________________

4. ______________________________________________________________________________

5. ______________________________________________________________________________

6. ______________________________________________________________________________

7. ______________________________________________________________________________

Your Name ____________________________________

Your address ___________________________________

___________________________________

Email ______________________________

Mail this page, a money order (which I prefer. You can get them from the Post Office) or a check and a self addressed stamped (make sure you put enough postage on the return envelope) #10 size (like your bills come in) ( or larger size, if you will be needing it) envelope to:

Jay Odom

3002 Blake St.

Corinth, TX

76210

*Females should be listed by last married name or the name they were

using at time of death.

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