This is a list of information you may need to know when you fill out the paperwork for the death certificate…
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Full Name of Deceased
Age
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
Occupation
Decedent’s Address (decedent means deceased)
City, County, State, Zip Code
Race
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
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