Family Information Sheet

VITAL RECORDS WORKSHEET

STATE OF COLORADO
DECEDENT'S NAME
FIRST, MIDDLE, LAST
Social Security Number
Gender
Date of Death

MonthDayYear
Date
Date of Birth

MonthDayYear
Date
Birthplace
State or Foreign Country or Unknown
Was decedent ever in US Armed Forces
Place of Death
Occupation (Type of work done during most of working life. Do NOT use retired)
If not known type in Unknown
Kind of Business/Industry
If not known type in Unknown
Marital Status
Spouse or Widows Full Name (if wife use last name prior to 1st marriage.)
Decedent Address

Street Address

Street Address Line 2

CityState

Zip Code
County
Inside City Limits
Was Decedent of Spanish Orgin

YES, Other Spanish/Hispanic/Latino (Specify below)
Decedent's Race
Education
Mother's Name (First, Middle, MAIDEN)
If not known type in Unknown
Father's Name (First, Middle, Last)
If not known type in Unknown
Informant's Name and (relationship to deceased)
Email
example@example.com
Phone Number
Format: (000) 000-0000.
I/we attest to the accuracy of the above information to be sent to the Colorado State Vital Records Office by Simply Cremation. Any corrections to data or the reissue of corrected certificates may incur a cost which must be paid by the family of the deceased or the party that requests the correction and/or new certificates.
Should be Empty:

VITAL RECORDS WORKSHEET