Fill Out Your Az Vsims Form
The Arizona VSIMS form plays a crucial role in documenting vital information about deceased individuals. This comprehensive worksheet gathers essential details such as the decedent's legal name, date of birth, and date of death. It also captures the circumstances surrounding the death, including the place of death—whether it occurred at home, in a hospital, or elsewhere. The form requires information about the decedent's marital status, education level, and race, providing a complete picture of the individual's background. Family details are also included, like the names of surviving spouses and parents. In addition, it records the decedent’s residence history and occupation, which can be important for various legal and administrative purposes. Finally, the form addresses the method of final disposition, whether through burial, cremation, or donation, ensuring that all aspects of the decedent's life and passing are thoroughly documented. This information is vital for public health records, statistical analysis, and fulfilling legal obligations related to death certification.
Guide to Writing Az Vsims
Completing the Arizona Vsims form is a crucial step in documenting important details related to a decedent. This process requires careful attention to detail to ensure that all information is accurately recorded. Below are the steps to guide you through filling out the form.
- Begin with the decedent's legal name, including first, middle, last, and any suffix.
- If applicable, list any known aliases.
- Enter the date of death in the specified format.
- Indicate the actual found sex of the decedent.
- Provide the decedent's social security number.
- Record the date of birth and age, specifying if the decedent was under 1 year, under 1 day, or unknown.
- Choose the place of death from the provided options, or specify another location.
- If the place of death is a facility, include the name and address of that facility.
- Document the time of death, specifying AM or PM.
- Select the military marital status of the decedent.
- Fill in the first, middle, last name, and suffix of the surviving spouse, if applicable.
- Indicate the highest level of education achieved by the decedent.
- Select all applicable races of the decedent.
- Check the box that best corresponds with the decedent’s Hispanic origin.
- Provide the birth information, including country, state, county, and city.
- Fill in the decedent's residence address, including street, apartment/unit number, city, state, and ZIP code.
- Indicate how long the decedent lived in Arizona and whether they lived in city limits or on an Arizona reservation.
- Record the decedent's occupation and industry.
- Fill in the names of the decedent's parents, including any suffixes.
- Provide the informant's details, including name, relationship to the deceased, and mailing address.
- Document the date of final disposition and select the method(s) of disposition.
- Include the name, city, and state of the first and second disposition facilities or crematories.
- List the name and address of the funeral home and the name of the funeral director, along with their license number.
- Lastly, ensure that the informant and funeral director sign and date the form, confirming the accuracy of the information provided.
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Common Questions
What is the purpose of the Arizona Vsims form?
The Arizona Vsims form is designed to collect essential information about a deceased individual for the purpose of documenting vital statistics. This information is crucial for maintaining accurate public records and ensuring that the deceased's identity is properly recognized. It includes details such as the decedent's legal name, date of death, place of death, and demographic information, which can aid in various administrative processes following a death.
What information is required on the Arizona Vsims form?
The form requires comprehensive details about the decedent. Key information includes the legal name, date of birth, social security number, place of death, and marital status. Additionally, it asks for the decedent's race, education level, occupation, and the names of their parents. Each section is designed to capture specific data that can assist in the accurate recording of vital statistics.
Who is responsible for completing the Arizona Vsims form?
The responsibility for completing the Arizona Vsims form typically falls to the informant, who is often a family member or close associate of the deceased. In some cases, a funeral director may assist in gathering the necessary information. It is important that the informant provides accurate and truthful information to ensure the integrity of the records.
How is the information on the Arizona Vsims form used?
The information collected on the Arizona Vsims form is used to create official death certificates and maintain vital records in Arizona. These records are essential for legal, medical, and genealogical purposes. They can also be used to facilitate the settlement of the deceased's estate and help surviving family members navigate various administrative tasks related to the death.
What should I do if I do not have all the information requested on the form?
If certain information is not available, it is important to indicate this on the form by selecting the appropriate option, such as "unknown" or "not obtainable." It is better to provide as much information as possible, but acknowledging missing details ensures that the record remains accurate and transparent. The informant should work closely with the funeral director to fill out the form to the best of their ability.
Where do I submit the completed Arizona Vsims form?
Once completed, the Arizona Vsims form should be submitted to the appropriate local vital records office or the funeral home handling the arrangements. The funeral home typically takes care of filing the form with the necessary authorities to ensure that the death is officially recorded. It is advisable to keep a copy of the completed form for personal records.
Dos and Don'ts
When filling out the Arizona VSIMS form, attention to detail is crucial. Here’s a list of things you should and shouldn’t do to ensure the process goes smoothly.
- Do double-check all information: Ensure that names, dates, and other critical details are accurate. Errors can lead to complications later.
- Do use clear handwriting: If you’re filling out a paper form, make sure your handwriting is legible. This helps prevent misunderstandings.
- Do include all required information: Make sure to fill out every section that applies. Omitting information can delay processing.
- Do consult with a funeral director: If you have questions or need assistance, don’t hesitate to ask a professional for help.
- Don't leave any sections blank: If a question doesn’t apply, write “N/A” instead of leaving it empty.
- Don't rush through the form: Take your time to ensure everything is filled out correctly. Hasty mistakes can be costly.
- Don't forget to sign: Make sure that both the informant and the funeral director sign the form where required.
- Don't provide inaccurate information: Always provide truthful and precise details. Misrepresentation can lead to legal issues.
Similar forms
The Arizona VSIMS form is similar to the Death Certificate, which is a vital record that officially documents a person's death. Like the VSIMS form, a Death Certificate includes essential details such as the decedent's name, date of birth, date of death, and place of death. Both documents serve to provide legal acknowledgment of an individual's passing, ensuring that the necessary information is recorded for government and legal purposes.
Another document comparable to the Arizona VSIMS form is the Medical Examiner's Report. This report outlines the circumstances surrounding a death, including the cause and manner of death. Similar to the VSIMS form, it collects demographic information about the deceased and is often used in legal contexts. Both documents play crucial roles in understanding the details of a person's death and may be required for various administrative processes.
The Autopsy Report also shares similarities with the Arizona VSIMS form. This document provides a detailed examination of the deceased's body to determine the cause of death. Like the VSIMS form, it requires personal information about the decedent and is used by medical professionals, law enforcement, and families. Both documents are vital for clarifying the circumstances of a death and can influence legal and insurance matters.
A Funeral Home Record parallels the Arizona VSIMS form in that it contains critical information about the deceased and the arrangements made after death. This record includes the decedent's personal details, the funeral service chosen, and the final disposition method. Both documents ensure that the wishes of the deceased and their family are respected and documented accurately for future reference.
The Cremation Authorization Form is another document similar to the Arizona VSIMS form. This form is required when a body is to be cremated and includes information about the deceased, the authorizing party, and the details of the cremation process. Like the VSIMS form, it confirms consent and provides a record of the decedent's information, ensuring compliance with legal requirements.
The Burial Permit is also akin to the Arizona VSIMS form. This permit is necessary for the burial of a deceased individual and typically includes details such as the decedent's name, date of death, and burial location. Both documents serve as official records that facilitate the final disposition of a body, ensuring that all legal protocols are followed.
The Life Insurance Claim Form shares commonalities with the Arizona VSIMS form as well. This form is submitted by beneficiaries to claim benefits after a policyholder's death. It requires information about the deceased, including their legal name and date of death, similar to the details found on the VSIMS form. Both documents are essential for processing claims and ensuring that beneficiaries receive the intended support.
The Social Security Administration Death Notification is another document that resembles the Arizona VSIMS form. This notification is used to inform the Social Security Administration of an individual's passing and includes personal information about the deceased. Both documents are vital for updating records and ensuring that benefits are managed appropriately following a death.
Lastly, the Will or Last Testament can be viewed as similar to the Arizona VSIMS form in that it addresses the wishes of the deceased after their passing. While the VSIMS form focuses on recording vital statistics, the Will outlines how the decedent's assets should be distributed. Both documents are essential for ensuring that the legal and personal affairs of the deceased are handled according to their wishes and in compliance with the law.
Key takeaways
Filling out the Arizona Vsims form is a crucial step in documenting the details surrounding a decedent's passing. Here are some key takeaways to keep in mind:
- Accurate Information is Essential: Ensure that all personal details about the decedent, such as their legal name, date of death, and place of death, are filled out accurately. Mistakes can lead to complications in the processing of the form.
- Multiple Options for Race and Ethnicity: The form allows for multiple selections when indicating the decedent's race and Hispanic origin. Be thorough and select all applicable categories to provide a complete picture.
- Marital Status Matters: Clearly indicate the decedent's marital status. This information can impact the legal handling of their estate and may affect surviving family members.
- Informant’s Information is Required: The form requires the informant's name and relationship to the deceased. This helps establish a point of contact for any follow-up questions or clarifications.
- Final Disposition Details: Be prepared to specify the method of disposition, such as burial or cremation. This information is vital for legal and ceremonial purposes.
- Signature and Date: The form must be signed and dated by both the informant and the funeral director. This step confirms the accuracy of the information provided and is necessary for the form to be valid.
By keeping these key points in mind, individuals can ensure that the Arizona Vsims form is filled out correctly and efficiently, facilitating the necessary legal processes following a death.
Common mistakes
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Incomplete Information: Failing to fill out all required fields can lead to delays. Each section must be completed fully to ensure accurate processing.
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Incorrect Dates: Entering the wrong date of death or birth can cause significant issues. Double-check all dates for accuracy.
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Missing Social Security Number: Not providing the decedent’s Social Security number can hinder the verification process. This information is often essential.
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Unclear Place of Death: Specifying "other" without providing clear details can lead to confusion. Always include specific addresses or names of facilities.
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Incorrect Marital Status: Misidentifying the marital status can affect the distribution of assets. Ensure the correct status is selected.
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Race and Ethnicity Errors: Failing to accurately select the decedent's race or ethnicity can lead to misrepresentation. Check all options carefully.
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Omitting Informant Details: Not providing complete information about the informant can delay processing. Include full names and addresses.
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Education Level Mistakes: Selecting the wrong education level can misrepresent the decedent's background. Review the options before making a selection.
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Signature Issues: Not signing the form or providing an illegible signature can cause complications. Ensure that all signatures are clear and complete.
Document Preview
ARIZONA VSIMS WORKSHEET
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DECEDENT’S LEGALNAME (FIRST, MIDDLE, LAST, SUFFIX) |
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AKA’S (IF ANY) |
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DATE OF DEATH |
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ACTUAL |
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FOUND |
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SEX |
SOCIAL SECURITY NUMBER |
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DATE OF BIRTH |
AGE |
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UNDER 1 YEAR |
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UNDER 1 DAY |
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UNKNOWN |
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MONTHS |
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DAYS |
HRS |
MINS |
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_____ /____/______ _ |
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NONE |
____/____/_______ |
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PLACE OF DEATH: |
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DEAD ON ARRIVAL |
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ER OUTPATIENT |
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HOSPICE FACILITY |
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INPATIENT |
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DECEDENT’S RESIDENCE |
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NURSING HOME/LONG TERM CARE |
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OTHER (SPECIFY) ___________________________________________ PLACE OF DEATH FACILITY _____________________________________________________ |
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SPECIFY OTHER INSTITUTION OR SPECIFY STREET, NUMBER, CITY, COUNTY & ZIP: |
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TIME OF DEATH |
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AM
PM
MILITARY
MARITAL STATUS:
DIVORCED
MARRIED |
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MARRIED BUT SEPARATED |
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NEVER MARRIED |
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NOT OBTAINABLE |
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UNKNOWN |
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WIDOWED |
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FIRST NAME OF SURVIVING SPOUSE |
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MIDDLE NAME OF SURVIVING SPOUSE |
LAST NAME OF SURVIVING SPOUSE |
SUFFIX |
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LAST NAME OF SURVIVING SPOUSE PRIOR TO FIRST MARRIAGE |
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EDUCATION (SELECT ONE) |
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8TH grade or less |
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9th |
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High School Grad/ GED completed |
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Associate Degree (e.g. AA, AS) |
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Bachelor’s Degree (e.g. BA, BS) |
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Master’s Degree (e.g.: MA, MS, MEng,etc) |
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Not Obtainable |
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Unknown |
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Refused |
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Not Classifiable |
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Some College Credit but No Degree Doctorate (e.g.: PhD, EdD, MD, DO)
DECEDENT’S RACE (SELECT ALL THAT APPLY)

WHITE

BLACK OR

AMERICAN INDIAN OR ALASKA NATIVE
PRIMARY OR ENROLLED TRIBE: __________________________
SECOND TRIBE (OPTIONAL): |
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ADDITIONAL TRIBE: |
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ADDITIONAL TRIBE: |
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ASIAN INDIAN |
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CHINESE |
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FILIPINO |
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JAPANESE |
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KOREAN |
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VIETNAMESE |
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OTHER ASIAN (SPECIFY) |
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NATIVE HAWAIIAN |
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GUAMANIAN OR CHAMORRO |
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SAMOAN

OTHER PACIFIC ISLANDER (SPECIFY) _____________________________________
OTHER (SPECIFY) |
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UNKNOWN |
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REFUSED |
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NOT OBTAINABLE |
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DECEDENT’S HISPANIC ORIGIN: CHECK THE BOX THAT BEST CORRESPONDS WITH THE DECEDENT’S ETHNIC IDENTITY AS GIVEN BY THE INFORMANT.
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NOT SPANISH, HISPANIC OR LATINO |
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OTHER (SPECIFY) |
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MEXICAN, MEXICAN AMERICAN OR CHICANO |
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UNKNOWN |
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PUERTO RICAN |
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REFUSED |
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CUBAN |
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NOT OBTAINABLE |
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BIRTH INFORMATION: |
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________________________ |
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BIRTH COUNTRY |
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BIRTH STATE |
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BIRTH CITY |
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DECEDENT’S RESIDENCE ADDRESS: |
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____________________________________ |
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______________ |
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DECEDENT’S STREET ADDRESS |
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APT/UNIT# |
CITY |
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STATE |
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ZIP CODE |
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_________________________ |
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__________________________________ |
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DAYS |
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WEEKS |
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MONTHS |
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YEARS |
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RESIDENCE COUNTY |
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HOW LONG IN ARIZONA |
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YES |
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NO |
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UNKNOWN |
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YES |
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NO |
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UNKNOWN |
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_____________________________________________________ |
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IN CITY LIMITS |
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ON AZ RESERVATION |
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IF YES, NAME OF ARIZONA RESERVATION |
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UNKNOWN |
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DECEDENT’S OCCUPATION |
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DECEDENT’S INDUSTRY |
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U.S. ARMED FORCES |
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______________________________ |
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FATHER’S FIRST NAME |
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MIDDLE NAME |
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LAST NAME |
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SUFFIX |
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______________________________ |
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________________________ |
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_________________________________________ |
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MOTHER’S FIRST NAME |
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MIDDLE NAME |
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MOTHER’S LAST NAME PRIOR TO FIRST MARRIAGE |
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INFORMANT |
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______________________ |
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________________________ ______________________________ __________ |
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________________________________ |
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FIRST NAME |
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MIDDLE NAME |
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LAST NAME |
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SUFFIX |
RELATIONSHIP TO DECEASED |
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______________________________________________________________________________________________ |
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________________ |
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INFORMANT’S MAILING ADDRESS (STREET, NUMBER, CITY, COUNTY, & ZIP CODE) |
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COUNTRY (IF NOT IN U.S.) |
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DISPOSITION: |
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DATE OF FINAL DISPOSITION |
_____/ _____/ _____ |
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METHOD(S) OF DISPOSITION |
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BURIAL |
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DONATION/BURIAL |
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REMOVAL/CREMATION |
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REMOVAL/DONATION/CREMATION |
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ENTOMBMENT |
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UNKNOWN |
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CREMATION |
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DONATION/CREMATION |
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REMOVAL/DONATION |
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REMOVAL/DONATION/ENTOMBMENT |
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REMOVAL FROM STATE |
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DONATION |
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DONATION/ENTOMBMENT |
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REMOVAL/BURIAL |
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REMOVAL/DONATION/BURIAL |
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REMOVAL/ENTOMBMENT |
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OTHER (SPECIFY) ____________________________________________ |
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REMOVAL/OTHER (SPECIFY) _____________________________________ |
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________________________________________________________ |
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___________________________________________________________ |
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NAME, CITY & STATE OF FIRST DISPOSITION FACILITY OR CREMATORY |
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NAME, CITY & STATE OF SECOND DISPOSITION FACILITY OR CEMETERY |
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________________________________________________________________ |
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______________________________________________ |
_______________ |
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NAME AND ADDRESS OF FUNERAL HOME |
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NAME OF FUNERAL HOME DIRECTOR |
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LICENSE NUMBER |
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TO THE BEST OF MY KNOWLEDGE, THE ABOVE INFORMATION OF THIS WORKSHEET IS TRUE AND CORRECT. |
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_____________________________________ |
___________________ |
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______________________________________________ |
________ |
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INFORMANT’S SIGNATURE |
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DATE SIGNED |
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SIGNATURE OF FUNERAL DIRECTOR |
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DATE SIGNED |
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Created by Maricopa County, V.1.0
Form Breakdown
| Fact Name | Fact Description |
|---|---|
| Form Purpose | The Arizona VSIMS Worksheet is used to collect vital information regarding a deceased individual for state records. |
| Governing Law | This form is governed by Arizona Revised Statutes Title 36, Chapter 3, which pertains to vital records. |
| Required Information | It requires details such as the decedent’s legal name, date of death, place of death, and personal identification details. |
| Place of Death Options | Options for place of death include hospital, hospice, residence, and other specified locations. |
| Marital Status | The form allows for various marital status options, such as married, divorced, and widowed, to be selected. |
| Education Level | Decedent’s education is categorized from no diploma to doctorate level, ensuring comprehensive data collection. |
| Race and Ethnicity | The form includes multiple options for race and ethnicity, allowing for a detailed understanding of the decedent's background. |
| Informant Details | Information about the informant, including their relationship to the deceased, is also required for accurate record-keeping. |