Vital Statistics Information2018-07-19T21:02:06+00:00
The information below is needed to process a Certified Death Certificate

Date of Birth:

Gender:

MaleFemale

Residence:

Background Information:


Inside City Limits:

YesNo

Armed Forces:

YesNo

Marital Status:

Spouse’s Name: (If wife, give name prior to first marriage)

Hispanic Origin: YesNo

Informant:


Mailing Address: