# Death Certificate

URL: https://pdf.net/pdf-forms/healthcare-forms/death-certificate
Category: Healthcare Forms
Attributes: E-signature
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A death certificate is an official document that records the time, location, and cause of death, serving as confirmation that a person has passed away.

Open the fillable death certificate form in our PDF editor and enter the required information into the empty fields. Once you do so, you can save the document on your device for further use.

## Versions

- 2003 — [download PDF](https://cdn.sanity.io/files/i16te7yp/production/ede9ca698d2a0f54e21310caeed99636af44d69f.pdf)

## How to Fill Out a Death Certificate?

Step 1: Select a blank death certificate form from our fillable PDF forms.

Step 2: Complete the first and third parts of the form (the deceased’s information, SSN, family details, education, and race) if you’re a funeral director.

Step 4: Complete the second part of the form (time and cause of death, the examiner’s details) if you’re a medical certifier.

Step 5: Review and sign the document.

Step 6: Submit the form to the vital records office.

## Facts

### What Is a Death Certificate Form?

A death certificate form is an official document recording the date, time, and cause of death and serving as proof that an individual has passed away. It is used for settling the deceased’s affairs (transferring assets, closing accounts) and obtaining life insurance or retirement benefits. Death certificates are also vital for legal and medical investigations.

### Who Is Required to Fill Out a Death Certificate Form?

Death certificates are filled out by physicians and funeral directors; the former complete the medical portion of the certificate, while the latter fill out demographic sections. If a death is suspicious or the cause is unknown, a coroner may complete the medical sections instead.

### When Should a Death Certificate Form Be Submitted?

A death certificate is submitted when a person passes away, and it’s typically first filed with the local or state vital records office within 72 hours of death. However, this process can last longer depending on the circumstances (for instance, if there’s an ongoing investigation into the cause).

### What Are the Penalties for Providing Incorrect Information?

Providing incorrect information on a death certificate is considered a felony and may result in significant fines and imprisonment. The exact sentence varies from state to state, but penalties may include fines of up to $10,000 and imprisonment for up to 10 years.

### How Do I Submit a Death Certificate Form?

Medical examiners and funeral directors submit death certificate forms to the vital records office of the state where the death occurred. To do so, they must obtain the necessary information about the deceased from the family and complete the form as instructed.

## Related forms

- [ Form SS-5](https://pdf.net/pdf-forms/legal-forms/ss-5-form)
- [SSA-521 Form](https://pdf.net/pdf-forms/legal-forms/ssa-521)
- [Form SSA-827](https://pdf.net/pdf-forms/legal-forms/ssa-827-form)
- [Form DD 2656](https://pdf.net/pdf-forms/healthcare-forms/form-dd-2656)
- [VA Form 21-526EZ](https://pdf.net/pdf-forms/military-forms/va-form-21-526ez)