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This is the information that you will need to provide to us in order that the death certificate can be completed and filed with the appropriate health department. If you wish, you may fill this form out, print it, and bring it to us when you come to make arrangements. If you do not wish to fill it out ahead of time, please gather the information requested before you meet with us.
Keep in mind that this information must be accurate since it will become a part of the death certificate which is a legal document and which will be used for legal purposes.

Vital Statistics Fillable Form

Click on the graphic on the left to download the file.

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