Record of Vital Information Form

Pre-Planning Resources

This form was prepared for your convenience to help provide a single source document of essential personal information to assist survivors after death occurs. This information is required to complete and file a death certificate with the State.

You may wish to complete more than one copy of this form. By all means, a family member or close friend should have a copy. It is desirable to give your funeral director a copy for his/her files. Your family or friends should know where you have placed this information. Do not lock the only copy in your safe deposit box.

We suggest that you discuss your wishes in detail with your funeral director who will provide careful counseling as a public service, with no obligation.