Vital Statistic Information

Required Basic Vital Statistic Information

This information is required to begin the documentation and death certificate process. Please enter all or as many fields as possible. You may skip over if you don’t know something and call/email us with that information later. We cannot start the documentation process without ALL of this information.

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Deceased Full Legal Name

First Name

Middle Name

Last Name

Maiden (if female)

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Most Recent Address of Deceased

Street Address

Address Line 2

City

State

State / Province / Region

ZIP/Postal Code

Ethnicity

Marital Status

Married

Widowed

Divorced

Never Married

Date of Birth

City & State of Birth

Field label

Father's Name

First Name

Last Name

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Mother's Name

First Name

Last Name

Maiden

Usual Occupation

Social Security Number

Branch of Military if Veteran

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Surviving Spouse Name

First Name

Middle Name

Last Name

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Informant or Next of Kin

This is the name and address that will appear on the death certificate of the person responsible for arrangements.

First Name

Middle Name

Last Name

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Address of Next of Kin / Informant

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Email Address

Cell Phone

Number of Death Certificates Requested

Vital Statistic Information

Required Basic Vital Statistic Information

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Callaway-Jones Funeral Home and Crematory