Florida Death Certificate Generator - Easy Affordable Cremation

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License: F840434 | (727) 300-9548

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FL Death Certificate

Why Us?
Our Process
What’s Included
Pricing
About
Grieving Without a Service
Contact

FL Death Certificate

Complete the form below and the Death Certificate well be sent to Easy Affordable Cremation. We’ll reach out with any questions.

Florida Death Certificate Generator

1. DECEDENT’S NAME (First, Middle, Last, Suffix)

2. SEX

3. DATE OF BIRTH

(Month, Day, Year)

4a. AGE – Last Birthday (Years)

5. DATE OF DEATH

(Month, Day, Year)

6. SOCIAL SECURITY NUMBER

7. BIRTHPLACE (City and State or Foreign Country)

8. COUNTY OF DEATH

9. PLACE OF DEATH (Check only one)

Inpatient

Emergency Room/Outpatient

Dead on Arrival

Hospice Facility

Nursing Home/Long Term Care Facility

Decedent’s Home

Other (Specify)

OTHER PLACE OF DEATH

10. FACILITY NAME (if not institution, give address)

11a. CITY, TOWN, OR LOCATION OF DEATH

11b. INSIDE CITY LIMITS?

Yes

No

12. MARITAL STATUS (Specify)

Married

Married, but Separated

Widowed

Divorced

Never Married

13. SURVING SPOUSE’S NAME (if wife, give maiden name)

14a. RESIDENCE – STATE

14b. COUNTY

14c. CITY, TOWN, OR LOCATION

14d. STREET ADDRESS

14e APT. NO

14f. ZIP CODE

14g. INSIDE CITY LIMITS?

Yes

No

15a. DECEDENT’S USUAL OCCUPATION (indicate type of work done during most of working life. Do not use “Retired”)

15b. KIND OF BUSINESS/INDUSTRY

16. DECEDENT’S RACE (Specify the race/races to indicate what decedent considered himself/herself to be. More than one race may be specified.)

White

White

Black or African American

Black or African American

American Indian or Alaskan Native

American Indian or Alaskan Native

Please Specify if American Indian or Alaskan Native

Asian Indian

Asian Indian

Chinese

Chinese

Filipino

Filipino

Japanese

Japanese

Korean

Korean

Vietnamese

Vietnamese

Other Asian

Other Asian

Please Specify if Other Asian

Native Hawaiian

Native Hawaiian

Guamanian or Chamorro

Guamanian or Chamorro

Samoan

Samoan

Other Pacific Isl.

Other Pacific Isl.

Please Specify if Other Pacific Isl.

Other

Other

Please Specify if Other

17. IS DECENDENT OF HISPANIC OR HAITIAN ORIGIN?

Yes (if Yes, specify)

No

Mexican

Mexican

Puerto Rican

Puerto Rican

Cuban

Cuban

Central/South American

Central/South American

Other Hispanic

Other Hispanic

Haitian

Haitian

Please Specify if Other Hispanic

18. DECEDENT’S EDUCATION (Specify the decedent’s highest degree or level of school completed at the time of death.)

8th or less

High school but no diploma

High school diploma or GED

College but no degree

Associate Degree

Bachelor’s Degree

Master’s Degree

Doctorate Degree

19. WAS DECEDENT EVER IN U.S. ARMED FORCES?

Yes

No

20. FATHER’S NAME (First, Middle, Last, Suffix)

21. MOTHER’S MAIDEN (First, Middle, Last, Suffix)

22a. INFORMANT’S NAME

22b. RELATIONSHIP TO DECEDENT

23a. INFORMANT’S MAILING – STATE

23b. CITY OR TOWN

23c. STREET ADDRESS

23d. ZIP CODE

Honest Pricing,
Dignified Services.

Fillable death certificate form

Click here download the PDF file.

Online Death Certificate Generator

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Contact Us

info@easyaffordablecremation.com

(727) 300-9548

3147 49th St N
St. Petersburg, FL 33710

Service Areas

Pinellas County
Pasco County
Hernando County
Hillsborough County
Manatee County
Sarasota County

Hours

For removal team: 24/7
For general questions: 8am to 4pm Monday through Friday
To check status: email us with deceased name in subject line.

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