Vital Statistics Information Form

Form name - click to options set

Prefix

First Name

Middle Name or Middle Initial ( Type NA for None)

Last Name

Generational ID

Sex

MaleFemale

Social Security Number ###-##-####

Date of Birth

Age

State of Birth ( U= Unknown)

City of Birth ( U= Unknown)

County of Birth ( U= Unknown)

Country of Birth ( Answer Only If Not United States )

Decedent's Address

Street

City

State/Province

ZIP/Postcode

County

Inside City Limits

Was Decedent in Military of Armed Forces ?

Decedent's Last Occupation ( U= Unknown) ( D= Disabled)

Kind of Business or Industry ( U= Unknown) (N= None)

Last Employer ( U= Unknown) (N= None)

Marital Status

Spouse Name First, Middle Name or Middle Initial, Last ( If Wife, Give Maiden Name) ( N=None)

Decedent's Fathers Name First, Middle Name or Middle Initial, Last ( N=None)

Decedent's Mothers Name (Maiden Name) First, Middle Name or Middle Initial, Last Name should be Maiden Name ( N=None)

Sunset Memorial Chapel, Inc
| 33558 US Highway 280
| Childersburg, AL 35044
| Tel: (256) 378-7199
| Fax: (256) 378-7193

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