Family information worksheet

Vital Statistics

Prepare the biographical details commonly requested during funeral arrangements and official-record coordination.

Organizational worksheet

Gather facts before your meeting.

This form helps a family organize information. It is not a New York City death certificate application or a substitute for verification by a licensed funeral director and medical certifier.

Legal identity

First name Middle nameLast name

Other names used, including maiden nameSex or gender as shown on legal records

Date of birthBirthplace: city and state or country

Usual home address

County or borough of residenceLength of time at this residence

Family information

Marital or partnership statusSurviving spouse or partner's full name

Father or parent's full nameFather or parent's birthplace

Mother or parent's full nameBirth or maiden name

Mother or parent's birthplace

Life history

Highest level of educationUsual occupation

Type of business or industryMilitary service

Race or races, as self-identifiedHispanic or Latino origin, as self-identified

Death and disposition information

Date of deathPlace of death

Burial, cremation, or other dispositionCemetery or crematory

Location of cemetery, crematory, or final disposition

Informant completing this worksheet

Full legal name Relationship

Mailing address

Phone numberEmail address

For your privacy: the worksheet is sent through an encrypted connection. Social Security numbers, identification documents, medical records, and payment-card information are intentionally not collected here. Provide them only through a separate, verified channel arranged by the funeral home.