EmailMe Form - Washington State Death Worksheet

Your Name *

Please start with your full name and best email contact. We need this to communicate with you and make sure you get a copy of your form. Thank You.

Your Email *

~ The Worksheet Starts Here ~

Decedents Legal Name (Include AKA's if any) *

Death Date *

MM / DD / YYYY

Sex *

Social Security Number *

~ Age-Last Birthday ~

Age *

Under 1 Year - For Infants Only

Under 1 Day - For Infants Only

County of Death *

Birthdate *

MM / DD / YYYY

~ Birthplace ~

(City, Town, or County) *

(State or Foreign Country) *

Decedent's Education *

Was Decedent of Hispanic Origin? *

Decedent's Race *

Was Decedent ever in U.S. Armed Forces? *

~ Residence ~

Number and Street (e.g., 624 SE 5th St.) (Include Apt. No.) *

City or Town *

County *

Tribal Reservation Name (if applicable)

State or Foreign Country *

Zip Code *

Inside City Limits? *

Estimated length of time at residence *

Marital Status at Time of Death *

Surviving Spouse's Name (Give name prior to first marriage) *

Usual Occupation (Indicate type of work done during most of working life. (DO NOT USE RETIRED). *

Kind of Business/Industry (Do not use Company Name) *

~ Parents' & Informant's Information ~

Father's Name (First, Middle, Last, Suffix) *

Mother's Name Before First Marriage (First, Middle, Last) *

Informant's Name *

Relationship to Decedent *

Informant's Phone Number *

Informant's Email Address *

Mailing Address Number and Street *

City or Town *

State *

Zip Code *

~ Place of Death ~

If Death Occurred in a Hospital *

If Death Occurred Somewhere Other than a Hospital *

Informants Signature (I declare the foregoing is true to the best of my knowledge.)
NOTE: Desktop/Laptop use your mouse to sign.
Mobile Device sign with your fingertip

Clear