Information includes some or all of the following: Place of death (county, city or town, street, and number, or hospital or institution), full name (if woman give maiden name, if veteran specify war), residence and length of stay in hospital or institution and community; sex; color or race; marital status (if married give maiden name of wife or husband's name in full); age of husband or wife if alive; if stillborn; age in years, months, and days; if less than a day hours and minutes; usual occupation, industry, or business; social security number; birthplace (city and state or country), names and birthplaces of mother and father (mother's maiden name); informant and address; date of death; certification of attendance and time of death; cause of death; other conditions; major findings of operations or autopsy; was disease related to occupation; signature of doctor and address; place of burial, cremation, or removal; date of burial; and name and address of funeral director.
