Vital Statistics for Death Certificate

Vital Statistics Form

To prepare a death certificate

Please complete each box in the form below as accurately as possible. You can also download a copy of the form here and email it to

  • MM slash DD slash YYYY
  • :
  • MM slash DD slash YYYY

Additional Required Forms

You MUST fill out all 3 forms in order to complete the process.

CT Cremation Permit Crematory Authorization