Vital Information

death certificate e-form

Our Death Certificate E-Form is a fast, secure, and convenient way to start the process of obtaining official death certificates for your loved one.

This easy-to-use electronic form allows you to provide the necessary details from the comfort of your home—no printing, scanning, or in-person appointments required.

If you're unsure about a specific detail, please enter “Unknown” or your best estimate. We’re here to review everything carefully and will follow up with any questions. Please let us know if you have any questions.

Online Preplanning Form

1-3) Decedent Name

4) Date of Birth

5) Decedent Age

6) Gender

7) Date Of Death

8) Time of Death

9) Birth STATE or Foreign Country

10) Social Security Number

11) Ever In US Armed Forces?

12) Marital Status

Married

Never Married

Widowed

Divorced

13) Highest Education Level

14-15) Hispanic, Latino, or Spanish?

16) Race(s)

17) Occupation

18) Kind of Business Industry

19) # Of Years In Occupation

19b) Was Decedent Homeless?

20-21,23, 25) Residential Address

22) Country of Residence

24) # Of Years in County

31-33) Father's Name

34) Father's Birth Place

35-37) Mother's Name

38) Mother's Birth Place

40a) Where Will The Go After Cremation?

40b) Address To The Location in 40a

42) Do You Want Embalming

27) YOUR Mailing Address

26) YOUR Relationship to Decedent

26b-d) YOUR FULL NAME

26e) YOUR Phone # With Area Code

27b) YOUR Email Address

Vital Information

death certificate e-form

Online Preplanning Form

Still Waters Cremation Services

A Year of Grief Support

Vital Information

death certificate e-form

Online Preplanning Form

Still Waters Cremation Services

A Year of Grief Support

Please wait

Please wait

You have been unsubscribed

You have been subscribed

Something went wrong