Death Certificate Order Form

Possible reasons/needs for ordering a death certificate include:

 

  • Life Insurance Proceeds
  • Sell or transfer stocks and bonds
  • Sell or transfer Real Property
  • Veterans Benefits
  • Social Security Benefits
  • Employee benefits and pensions
  • Bank and Loan transactions
  • IRS for Income Tax records

 

Thanks for taking the time to fill out our Death Certificate Request Form. The information provided on this form will help Cusimano Family Colonial Mortuary complete the death certificate.

 

Please complete (as much as possible) the information on the form and select 'Submit Request' at the end to send the request to us.

 

If you have any questions whatsoever, please contact Cusimano Family Colonial Mortuary at: 650-968-4453


 

NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

 


Deceased Vital Statistics for Death Certificate:

 

 
 

 

Informant/Person In Charge Information:

 

 
 
 

 

Other Information & Instructions

 

 

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