The following information is needed for the death certificate:

• Legal name of the deceased
  
• Social Security number
  
• Father's name
  
• Mother's name prior to first marriage
  
• Occupation and employer information
  
• Is the decedent of Hispanic Origin?
  
• Place of birth (City, State, or Country)
  
• Address of residence (street address, city, state, zip code)
  
• Did the deceased ever serve in the US Armed Forces?  If yes, which war?
  
• Decedent's highest education level
  
• Is the decedent under a doctor's care?
  
• Date of Birth
  
• Domestic status (single, married, widowed, divorced, domestic partner, civil union)
  
• Informant's name and mailing address.  Relationship to deceased
  
• Decedent's race