E-Form

Death Certificate

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.

Vital Information

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.

Please complete and submit the form below.

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 (type 'NONE' if there is NO social security number)

11) Ever In US Armed Forces?

12) Marital Status

13) Highest Education/Degree Level

14-15) Hispanic, Latino, or Spanish?

16) Race(s)

17) Decedent's Usual Occupation (Do not use 'RETIRED')

18) What Kind of Industry for Occupation?

19) # Of Years In Occupation

19b) Was Decedent Homeless?

20-21,23, 25) Decedent's Address

22) Last County of Residence

24) # Of Years in Last 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 Ashes Go After Cremation?

40b) What's the Address To the Location in 40a?

42) Do You Authorize Embalming Care?

27) What's YOUR Address?

26) What's YOUR Relationship to the Decedent?

26b-d) What's YOUR Full Name?

How would you like to receive the certificates?

Today's Date

E-Form

Death Certificate

Vital Information

Online Preplanning Form

Still Waters Direct Cremation

A Year of Grief Support

E-Form﻿

Death Certificate

Vital Information

Online Preplanning Form

Still Waters Direct Cremation

A Year of Grief Support

E-Form