Vital Statistics Form

  • Please complete the information below

Sections A & B must be fully complete as this information is required by the State of Florida to register a death. Sections C & D are optional.

A) Information about the deceased

A response is not required if the deceased did not have a middle name.

Required only if a female decedent was ever married.

Deceased's Legal Residence

Not required if no middle name or middle name unknown.

Not required if no middle name or middle name unknown.

Education

Choose highest level of education completed.

Veteran Information

If yes, please specify which branch of service.

Employment History

Homemaker is an occupation, as is Never Employed.

Surviving Spouse Address

Informant Information

Address

At least one telephone number whether home or cell must be provided

B) Type of Disposition

The final disposition of the decedent must be indicated.

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