Death Record Form - Utah Vital Records Page 4
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6Death Record Form
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12. Marital Status of the Deceased
Never Married
Divorced
Married
Married, but Separated
Widowed
Unknown
13. Spouse’s Name – Name Prior to First Marriage
_____________________________________________________________________________________________________________
First
_____________________________________________________________________________________________________________
Middle
___________________________________________________________________________________________ ________________
Last
Suffix
14. Decedent’s Usual Occupation
Indicate the type of work done during most of the decedent’s working life.
st
DO NOT USE RETIRED. (e.g. High School Teacher, Airman 1
Class, Electronic Assembler)
____________________________________________________________________________________________________________
15. In What Business or Industry did the Decedent Usually Work
(e.g. High School, Hospital, Air Force, Manufacturing, Computers, Retail – Department Store, Grocery Store)
____________________________________________________________________________________________________________
16. Where did the Decedent Usually Live
(PO BOX should not be entered)
__________________________________________________________________________________________ ________________
Address
Apartment #
____________________________ ____________________________ ____________________ ___________________________
State
City
Zip
Country if outside the US
Inside City Limits
Yes
No
Unknown
17. Parent or Father’s Name (Prior to First Marriage)
_____________________________________________________________________________________________________________
First
_____________________________________________________________________________________________________________
Middle
___________________________________________________________________________________________ ________________
Last
Suffix
18. Parent or Mother’s Name (Prior to First Marriage)
_____________________________________________________________________________________________________________
First
_____________________________________________________________________________________________________________
Middle
___________________________________________________________________________________________ ________________
Last
Suffix
19. Informant’s Name
_____________________________________________________________________________________________________________
First
_____________________________________________________________________________________________________________
Middle
___________________________________________________________________________________________ ________________
Last
Suffix
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