Vital Statistics – Gather Forms for Static Sites

Vial Statistics of Deceased Step 1

First Name of Deceased(Required)

Middle Name of Deceased*(Required)

Last Name of Deceased*(Required)

Home Address

City*(Required)

State*(Required)

Zip Code*(Required)

Gender:

Male

Female

Social Security Number

Family Information Step 2

Family Information

Never Married

Divorced

Married

Widowed

Domestic Partner

Spouse/Partner First Name(Required)

Spouse/Partner Middle Name(Required)

Spouse/Partner Last Name(Required)

Spouse/Partner Maiden Name (If Female)

Father’s First Name(Required)

Father’s Middle Name(Required)

Father’s Last Name(Required)

Mother’s First Name(Required)

Mother’s Middle Name(Required)

Mother’s Last Name(Required)

Phone(Required)

Biographical Information Step 3

Race (white, black, American Indian, etc.)nt Spouse/Partner Name

Ancestry (American, French, Irish, etc.)

Birth Address(Required)

Birth City(Required)

Birth State(Required)

Birth Zip Code(Required)

Birth Date

Age

Professional History Step 4

Occupation (kind of work done most of life, not retired)

Kind of business or industry employed with

Years of education, elementary/secondary

College degree

Informant (next of kin to contact) Step 5

First Name(Required)

Middle Name(Required)

Last Name(Required)

Relationship

Telephone

Telephone Mode

Landline

Cell Phone

Informant Physical Address(Required)

City(Required)

State(Required)

Zip Code

Informant Mailing Address(Required)

City(Required)

State(Required)

Zip Code