Decedent Information Form

 
 
 
Decedent Full Name *
Decedent Full Name
Please enter First and Middle name/initial in the First Name box
Date of Death
Date of Death
Date of Birth *
Date of Birth
Is decedent of Hispanic Origin *
Decedent's race *
Decedent Level of Education *
Was Decedent a Veteran of U.S. Military *
Marital Status *
Surviving Spouse (birth/maiden name)
Surviving Spouse (birth/maiden name)
Informant Name *
Informant Name
Informant Address *
Informant Address
Informant Phone Number *
Informant Phone Number
The kind of work that the person performed through most of their life. Do not use 'Retired'
Ex.- A machine operator's industry would be manufacturing, A teacher's industry would be education
Decedent's Address *
Decedent's Address
Father's Full Name *
Father's Full Name
if either name is unknown, enter unknown in box
Mother's Full (Maiden) Name *
Mother's Full (Maiden) Name
if either name is unknown, enter unknown in box
Please add anything else you may think is important for us to know or explanations for any responses