Required fields are marked with an "*". If you do not know the answer to a field, please enter "unknown" or "n/a".
Death Certificate Worksheet
* Date of Birth
* Race-Filipino, Black, Alaska Native, White, etc.
I understand the above information will appear on the Certificate of Death that is filed with the State of Alaska Bureau of Vital Statistics. I have read this information and confirm it is correct. I understand there is a charge for any corrections or changes made to the death certificate after it has been filed with the Bureau of Vital Statistics. I also understand this charge will be the responsibility of the person requesting the change.
* Relationship to the member