McComb&Wagner Death Certificate Info

Required Information needed to complete the Death Certificate and other necessary documents

DECEDENT INFORMATION

First Name*:

Middle Name:

Last Name*:

Social Security Number*:

Birthdate (MM/DD/YYYY)*:

Age*:

Gender*:

Male

Female

Telephone*:

Address*:

Residence County*:

Is Residence in City Limits?*:

Yes

Unknown

Estimated Length of Time at Residence*:

Birthplace (City, State, Country)*:

Citizenship*:

Race*:

If Hispanic, Specify:

Education (Highest Grade Completed)*:

Occupation (Most of Working Life/Not "Retired")*:

Industry of Occupation*:

Marital Status*:

Surviving Spouse Current Full Name*:

Surviving Spouse Maiden Name*:

Father's First Name*:

Father's Last Name*:

Mother's First Name*:

Mother's Maiden Name*:

Veteran- Yes/No?*:

Branch:

Please upload your DD214 discharge paperwork.

Discharge Papers:

CONTACT PERSON / INFORMANT

Relationship to Decedent*:

First Name*:

Middle Name:

Last Name*:

Social Security Number*:

Telephone*:

Address*:

Email*:

Do you have Power of Attorney?:

Yes

Submit POA or Designated Agent Paperwork:

Please wait

SERVICE AREA

_____________________

King - Pierce - Kitsap

Thurston - Mason

Lewis - Grays Harbor

Jefferson - Pacific

McComb&Wagner Death Certificate Info

VITAL INFORMATION