Vital Statistics Form
This form must be typed or printed clearly.
(Type of business, eg. factory, manufacturer)
(if wife, give maiden name)
(Do not use hispanic)
- This form is used to complete the death certificate, which is a legal document and filed with the
State of Florida. It is therefore important to fill completely and accurately with the proper spelling
of names and places. Corrections to the death certificates require 6 to 8 weeks and there are fees
I certify that to the best of my knowledge that all information is true and correct.