| Decedent Overview |
Data about the person listed on the certificate is in the Decedent Data section. Required field are highlighted in yellow. |
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| First Name |
First Name of the person listed on the certificate
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| Middle Name |
Middle Name of the person listed on the certificate
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| Last Name |
Last Name of the person listed on the certificate
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| Suffix |
Suffix (Mr., Mrs. Ms..)
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| Gender |
Gender of the person listed on the certificate
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| Date of Death |
Date of Death of the person listed on the certificate (Note - must be within the last 12 months) |
| City |
City where the death occurred |
| County |
County where the death occurred |
| Date of Birth |
Date of Birth of the person listed on the certificate |
| Social Security Number (if Known) |
Social Security Number of the person listed on the certificate (if known) |