Vital Statistics Form

Vital Statistics Information

This form will be used to complete death certificate. All required items are identified with an asterisk. If you do not have the complete information, please type unknown in the field and we will get the information at a later time.

First Name Last Name
(if applicable)

(If a Veteran)
(If a Veteran)

* Remember that there is no suggested number of death certificates. We recommend that you request a few extra copies in case something comes up.

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