OBITUARIES
ABOUT US
SERVICES
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OBITUARIES
ABOUT US
SERVICES
MERCHANDISE
- MERCHANDISE
PLAN AHEAD
ONLINE FORMS
RESOURCES

IMMEDIATE NEED 972-259-7644

Vital Statistics Form

Vital Statistics Form

Vital Statistics Form

Free Text

Personal Information of Deceased

Full Legal Name of Deceased

Sex

Date of Birth

City & State or City & Foreign Country of Birth

Social Security Number

Race

Was Decedent in US Armed Forces

Yes

No

Was Decedent ever a Peace Officer (Police Officer) in Texas

Yes

No

Education

8th Grade or Less

9th-12th, No Degree

High School Graduate or GED

Some College, No Degree

Associate

Bachelor's

Master's

Doctorate

Marital Status

If Married, Surviving Spouse's Full Name ( include maiden name, if wife)

Decedent's Usual Occupation During Most of Life

Kind of Business or Industry

Free Text

Decedent's Residence Street Address

Street

City

State

ZIP/Postcode

Is Residence Inside City Limits

Decedent's Father's Name

Decedent's Mother's Full Name (including maiden name)

Decedent's Date of Death

Decedent's Place of Death

Street

City

State

ZIP/Postcode

Informant's Name

Relationship of Informant

Free Text

Mailing Address of Informant

Street

City

State/Province

ZIP/Postcode

Phone Number of Informant

Email Address of Informant

Number of Certified Copies of Death Certificates

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Visit www.prepaidfunerals.texas.gov for information relating to the purchase of pre-need funeral contracts including descriptions of the trust and insurance funding options available under state law.

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