Online Forms

Required Information for a Death Certificate

Please Have Informant Fill Out information: Death Certificate Vital Information

If you have any questions, or would like assistance with this form, please call 228-467-9031

Death Certificate Vital Information Form

Decedent's Legal Name

Race

Other :

Gender

Age at Last Birthday

Date of Birth

Birthplace

Decedent's Education

Marital Status

If Married- Spouse’s Name

Decedent Of Hispanic Origin:

Yes

Was Deceased Ever In U.S. Armed Forces?

Yes

Decedent’s Social Security Number

Decedent’s Usual Occupation

Industry or Business of Decedent's Occupation

Decedent's Address

County

City

State

Zip Code

Residence In City Limits

Yes

Father's Name

Mother's Name PRIOR To First Marriage

Informant's Name

Relationship

Informant's Mailing Address

Cemetery

Location

Number of Death Certificates Requested

Information Provided By

Free Text

Who is submitting this form? Please fill out the fields below.

Name

Phone Number

Email Address

228-467-9031

228-467-9031

Online Forms

Required Information for a Death Certificate

Death Certificate Vital Information Form

- F E E L F R E E T O -

Keep In Touch

Edmond Fahey Funeral Home

Gulf Coast Memorial Cemetery and Mausoleum

Crestlawn Memorial Park Cemetery

D'Iberville Memorial Park Cemetery

Bradford O'Keefe Funeral Home - 15th Street

Bradford O'Keefe Funeral Home - Howard Avenue

Bradford O'Keefe Funeral Home - Ocean Springs

Bradford O'Keefe Funeral Home - O'Neal Road

Bradford O'Keefe Funeral Home - Pass Road

Bradford O'Keefe Funeral Home - Vancleave

A Year of Grief Support