information for death certificate

This is a list of information you may need to know when you fill out the paperwork for the death certificate… 


Full Name of Deceased


Male/ Female 

Date of Death

Time of Death

Social Security Number

Place of Death / Address

City and State

Date of Birth

Place of Birth

Surviving Spouse (maiden name) 

Armed Forces  Yes/No

Marital Status


Decedent’s Address (decedent means deceased) 

     City, County, State, Zip Code  


Education (number of years)

Father’s Name

Mother’s Maiden Name

Name and address of Informant (the person providing the information)

Phone  Email 

Doctor’s Name and Address

Date of Service

Place of Service

Time of Service

Place of Burial

Number of Certificates 


information for death certificate