Free Missouri Certificate Of Death PDF Template

How to Use Missouri Certificate Of Death

Filling out the Missouri Certificate of Death form is an essential step in the process of officially documenting a death. This form collects important information about the deceased and the circumstances surrounding their passing. Once completed, the form should be submitted to the appropriate authorities to ensure proper record-keeping.

1. Decedent's Legal Name: Enter the full legal name of the deceased, including any aliases.
2. Sex: Indicate the sex of the deceased.
3. Last Name Prior to First Marriage (if female): Fill in the last name of the deceased before their first marriage, if applicable.
4. Date of Death: Provide the date of death in the format of month, day, and year.
5. Social Security Number: Enter the deceased's social security number.
6. Age: Specify the age of the deceased at the time of death, including their last birthday. If under one year, indicate the months, days, hours, and minutes as necessary.
7. Date of Birth: Fill in the date of birth using the month, day, and year format.
8. Birthplace: Provide the city and state or foreign country where the deceased was born.
9. Residence: List the country, state, county, city, street address, apartment number, and zip code of the deceased's residence.
10. Inside City Limits: Indicate whether the residence is within city limits (Yes or No).
11. Marital Status at Time of Death: Select the appropriate marital status of the deceased.
12. Surviving Spouse’s Name: If applicable, provide the name of the surviving spouse, including their name prior to the first marriage.
13. Parents' Names: Enter the names of the father and mother, including the mother's name prior to her first marriage.
14. Informant’s Name: Fill in the name of the informant, their relationship to the deceased, and their mailing address.
15. Place of Death: Check the appropriate box to indicate where the death occurred, such as a hospital or at home.
16. Facility Name: If applicable, provide the name of the facility where the death occurred.
17. County of Death: Enter the county where the death took place.
18. Method of Disposition: Indicate how the body was handled after death, such as burial or cremation.
19. Date of Disposition: Provide the date when the body was disposed of.
20. Place of Disposition: Specify the name and location of the cemetery, crematory, or other place of disposition.
21. Funeral Facility: Include the name and complete address of the funeral facility involved.
22. Signature of Funeral Service Licensee: The funeral service licensee or another authorized person must sign the form.
23. Time of Death: Enter the actual or presumed time of death.
24. Medical Examiner/Coroner Contacted: Indicate whether the medical examiner or coroner was contacted.
25. Cause of Death: Provide detailed information about the cause of death, including any relevant conditions leading to death.
26. Autopsy Information: Indicate whether an autopsy was performed and if findings were available.
27. Tobacco Use: Specify if tobacco use contributed to the death.
28. Manner of Death: Select the appropriate manner of death from the provided options.
29. Date and Time of Injury: If applicable, provide the date and time of any injury related to the death.
30. Place of Injury: Describe where the injury occurred.
31. Injury at Work: Indicate whether the injury occurred at work.
32. Describe How Injury Occurred: Provide a detailed description of how the injury occurred.
33. Certifier Information: The certifying physician or medical examiner must check the appropriate box and sign the form, providing their details.
34. Registrar’s Signature: The registrar will sign and date the form upon filing.

Filling out the Missouri Certificate of Death form is an important task that requires careful attention to detail. Here are some key takeaways to keep in mind:

• Accurate Information: Ensure that all information provided, such as the decedent's legal name and date of birth, is accurate. This helps avoid complications in the future.
• Chain of Events: When detailing the cause of death, clearly outline the chain of events leading to the death. Avoid using abbreviations and provide thorough explanations for each condition listed.
• Informant Details: The informant’s name and relationship to the decedent must be clearly stated. This information is crucial for verifying the details of the death.
• Timely Submission: Submit the completed form promptly to the appropriate registrar. Delays in filing can lead to issues with obtaining death certificates and related legal documents.