The Vital Statistics information is the most immediately needed following the death. The following information will be needed for the death certificate:

Full Name of deceased

Maiden Name if applicable

Sex

City and State of Birth

Age (last birthday)

Date of Birth

Social Security Number

Residence Street and Number, City, County, State, Zip Code

Race (White, Black, American Indian, etc.)

Ancestry (Italian, Mexican, German, etc.)

Marital Status (married, never married, widowed, divorced)

Name of Spouse

Usual Occupation

Business Industry

Education (specify only highest grade completed)

Father’s name

Mother’s name

Was deceased ever in the armed forces? (yes, no or unknown)
     If yes, give war(s) and dates of service

Informant’s Name (person providing information for death certificate)

Informant’s mailing address

Obituary

The Obituary information includes the vital statistics information and the following:

How long was the deceased at the current address?
     If less than two years, list the address considered the primary residence.
     How long at that address?

Citizenship

Anniversary date

Number of years married and if applicable, date of spouses death

Father’s Date and Place of Birth

Mother’s Date and Place of Birth

Mother’s Maiden Name

Number of Children

Number of Grandchildren

Number of Great-Grandchildren

Names of survivors (include name, relationship, city and state)

Preceded in death by

Religious denomination

Church/Temple/Mosque attended

If the deceased served in the military:
     Branch of Military Service
     Serial Number
     Date of Induction
     Highest Rank Achieve
     Honorable Discharge?

High School attended and year of graduation

College attended, major, degrees received, year of graduation

Other degrees/certificates received

Employer (most recent or longest term) and years at work

Public Office, Fraternal Organizations, Clubs or Community Involvement

Honors, Achievements, or Awards

Other information you would like to add

Funeral Services

Location of Service (church, temple, funeral home, etc.)

Officiant of Service (clergy, minister, other)

Religious Affiliation

Person responsible for arrangements and relationship to deceased

Contact information of family and friends to notify

Pallbearers

Speakers

Favorite Instrument

Favorite Hymns or Songs

Favorite scriptures or readings

Favorite prayers

Favorite Color

Favorite Flower

Does the family prefer donations in lieu of flowers?
     If yes, what memorial charity or organization

If military veteran, will flag drape casket?

Any additional preferences not considered above

Memorial Services

Location of Service (church, temple, funeral home, etc.)

Officiant of Service (clergy, minister, other)

Religious Affiliation

Person responsible for arrangements and relationship to deceased

Contact information of family and friends to notify

Speakers

Favorite Instrument

Favorite Hymns or Songs

Favorite scriptures or readings

Favorite prayers

Favorite Color

Favorite Flower

Does the family prefer donations in lieu of flowers?
     If yes, what memorial charity or organization

Special Interests

Hobbies

Goals or Plans

Major Accomplishments

Video or Slide Show to be included in service

Any additional preferences not considered above