Please carefully read the instructions before beginning.
You will be asked a series of questions required by the State of California to complete a death certificate. There may be information you do not know. Please try to be as thorough as possible because this information will be printed on the death certificate. Here is some information you will need along the way.
- Decedents social security number, place of residence, work history, education, and marital information.
- Decedents parents information (name and state of birth).
- Physicians information
Important to Note – No form field can be left blank. Use the term "Unknown" for any information you do not have. The word "Unknown" will be printed on the death certificate for these fields.
Once the information has been gathered you will be prompted to print the forms, which will have the information you just entered auto-populated. Please sign and date the necessary areas. These areas will be marked with red symbols, so they are easy to find. Once completed, fax the form to (415) 861-9866. If you have any difficulties feel free to email us at firstname.lastname@example.org, or call us at (415) 431-4900.