Az Vsims Form PDF Details

When a loved one passes away in Arizona, the process of officially recording their death involves completing a vital document known as the Arizona VSIMS Worksheet. This comprehensive form records crucial details about the deceased, such as their legal name, any other names they might have been known by (AKAs), the date and place of their death, and their social security number. Additionally, it delves into more personal details like marital status, education level, race, Hispanic origin, and even the decedent's occupation and industry. The VSIMS form also covers specifics about the death itself, including the exact time of death, whether it occurred in a hospice facility, at the decedent's residence, or elsewhere. This form plays a pivotal role in ensuring that the death is documented accurately, allowing for a proper legal and societal acknowledgment of the individual's passing. It serves not only as a record for official use but also aids in the closure process for grieving families, providing a structured way to capture the decedent's final details, including burial or cremation preferences, thoroughly and respectfully.

QuestionAnswer
Form NameAz Vsims Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesvsims, GUAMANIAN, ALASKA, MEngetc

Form Preview Example

ARIZONA VSIMS WORKSHEET

 

DECEDENT’S LEGALNAME (FIRST, MIDDLE, LAST, SUFFIX)

 

AKA’S (IF ANY)

 

 

 

 

 

 

DATE OF DEATH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACTUAL

 

 

FOUND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SEX

SOCIAL SECURITY NUMBER

 

 

 

DATE OF BIRTH

AGE

 

UNDER 1 YEAR

 

UNDER 1 DAY

 

 

 

 

 

 

 

 

UNKNOWN

 

 

 

 

 

 

 

 

MONTHS

 

 

DAYS

HRS

MINS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_____ /____/______ _

 

 

NONE

____/____/_______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLACE OF DEATH:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEAD ON ARRIVAL

 

ER OUTPATIENT

 

 

HOSPICE FACILITY

 

 

INPATIENT

 

 

DECEDENT’S RESIDENCE

 

NURSING HOME/LONG TERM CARE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER (SPECIFY) ___________________________________________ PLACE OF DEATH FACILITY _____________________________________________________

 

 

 

 

 

 

 

 

SPECIFY OTHER INSTITUTION OR SPECIFY STREET, NUMBER, CITY, COUNTY & ZIP:

 

 

 

 

TIME OF DEATH

 

 

 

 

 

 

 

__________________________________________________________________________________________

AM

PM MILITARY

MARITAL STATUS:

DIVORCED

MARRIED

 

MARRIED BUT SEPARATED

 

NEVER MARRIED

 

NOT OBTAINABLE

 

UNKNOWN

 

WIDOWED

 

 

 

 

 

 

 

FIRST NAME OF SURVIVING SPOUSE

 

MIDDLE NAME OF SURVIVING SPOUSE

LAST NAME OF SURVIVING SPOUSE

SUFFIX

LAST NAME OF SURVIVING SPOUSE PRIOR TO FIRST MARRIAGE

 

 

 

 

EDUCATION (SELECT ONE)

 

8TH grade or less

 

 

9th -12th grade No diploma

 

High School Grad/ GED completed

 

 

 

 

 

 

 

 

 

Associate Degree (e.g. AA, AS)

 

Bachelor’s Degree (e.g. BA, BS)

 

Master’s Degree (e.g.: MA, MS, MEng,etc)

 

 

Not Obtainable

 

Unknown

 

 

 

Refused

 

 

 

Not Classifiable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Some College Credit but No Degree Doctorate (e.g.: PhD, EdD, MD, DO)

DECEDENT’S RACE (SELECT ALL THAT APPLY)

WHITE

BLACK OR AFRICAN-AMERICAN

AMERICAN INDIAN OR ALASKA NATIVE

PRIMARY OR ENROLLED TRIBE: __________________________

SECOND TRIBE (OPTIONAL):

__________________________

ADDITIONAL TRIBE:

__________________________

ADDITIONAL TRIBE:

__________________________

ASIAN INDIAN

 

CHINESE

 

FILIPINO

 

JAPANESE

 

KOREAN

 

VIETNAMESE

 

OTHER ASIAN (SPECIFY)

______________________________________

NATIVE HAWAIIAN

 

GUAMANIAN OR CHAMORRO

 

SAMOAN

OTHER PACIFIC ISLANDER (SPECIFY) _____________________________________

OTHER (SPECIFY)

_____________________________________

UNKNOWN

 

REFUSED

 

NOT OBTAINABLE

 

DECEDENT’S HISPANIC ORIGIN: CHECK THE BOX THAT BEST CORRESPONDS WITH THE DECEDENT’S ETHNIC IDENTITY AS GIVEN BY THE INFORMANT.

 

 

NOT SPANISH, HISPANIC OR LATINO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER (SPECIFY)

_______________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MEXICAN, MEXICAN AMERICAN OR CHICANO

 

 

 

 

 

 

 

 

 

 

 

 

 

UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PUERTO RICAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REFUSED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CUBAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOT OBTAINABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTH INFORMATION:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

________________________

 

 

 

__________

 

 

________________________

 

 

 

 

 

 

 

_____________________________

 

BIRTH COUNTRY

 

 

BIRTH STATE

BIRTH COUNTY

 

 

 

 

 

 

 

 

BIRTH CITY

 

 

 

 

 

DECEDENT’S RESIDENCE ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________________________________

 

_________

 

___________________

_________

 

 

 

 

 

______________

 

 

 

DECEDENT’S STREET ADDRESS

 

 

 

 

 

 

 

 

APT/UNIT#

CITY

 

STATE

 

 

 

 

 

 

ZIP CODE

 

 

 

 

 

_________________________

 

 

__________________________________

_______

 

DAYS

 

 

 

WEEKS

 

MONTHS

 

 

YEARS

 

 

 

 

 

 

 

 

 

 

 

RESIDENCE COUNTY

 

 

RESIDENCE COUNTRY

 

 

 

 

 

 

HOW LONG IN ARIZONA

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

NO

 

 

UNKNOWN

 

 

YES

 

 

NO

 

UNKNOWN

 

 

 

 

 

_____________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IN CITY LIMITS

 

 

 

 

 

 

ON AZ RESERVATION

 

 

 

 

 

IF YES, NAME OF ARIZONA RESERVATION

 

 

 

 

 

____________________________________

 

________________________________________

 

 

 

 

 

 

 

YES

 

 

NO

 

UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

DECEDENT’S OCCUPATION

 

 

 

 

 

 

 

 

DECEDENT’S INDUSTRY

 

 

 

 

 

 

 

 

 

U.S. ARMED FORCES

 

 

 

 

 

______________________________

 

________________________

 

 

 

 

 

__________________________

 

 

 

 

 

 

 

___________

 

 

 

 

FATHER’S FIRST NAME

 

 

MIDDLE NAME

 

 

 

 

 

LAST NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

SUFFIX

 

 

 

 

 

______________________________

 

________________________

 

 

 

 

 

_________________________________________

 

 

 

 

 

 

 

 

MOTHER’S FIRST NAME

 

 

MIDDLE NAME

 

 

 

 

 

MOTHER’S LAST NAME PRIOR TO FIRST MARRIAGE

 

 

 

 

 

INFORMANT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

______________________

 

________________________ ______________________________ __________

 

 

 

 

 

________________________________

 

FIRST NAME

 

 

 

 

MIDDLE NAME

 

 

 

 

 

 

LAST NAME

 

SUFFIX

RELATIONSHIP TO DECEASED

 

______________________________________________________________________________________________

 

 

 

 

 

 

 

 

 

 

________________

 

 

 

INFORMANT’S MAILING ADDRESS (STREET, NUMBER, CITY, COUNTY, & ZIP CODE)

 

 

 

 

 

 

 

 

 

COUNTRY (IF NOT IN U.S.)

 

DISPOSITION:

 

DATE OF FINAL DISPOSITION

_____/ _____/ _____

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

METHOD(S) OF DISPOSITION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BURIAL

 

 

DONATION/BURIAL

 

 

 

 

REMOVAL/CREMATION

 

 

 

 

REMOVAL/DONATION/CREMATION

 

 

 

ENTOMBMENT

 

UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CREMATION

 

 

DONATION/CREMATION

 

 

 

 

REMOVAL/DONATION

 

 

 

 

 

REMOVAL/DONATION/ENTOMBMENT

 

 

 

REMOVAL FROM STATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DONATION

 

 

DONATION/ENTOMBMENT

 

 

 

 

REMOVAL/BURIAL

 

 

 

 

 

REMOVAL/DONATION/BURIAL

 

 

 

REMOVAL/ENTOMBMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER (SPECIFY) ____________________________________________

 

 

 

 

 

REMOVAL/OTHER (SPECIFY) _____________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

________________________________________________________

 

 

 

 

 

 

___________________________________________________________

 

NAME, CITY & STATE OF FIRST DISPOSITION FACILITY OR CREMATORY

 

 

 

 

 

NAME, CITY & STATE OF SECOND DISPOSITION FACILITY OR CEMETERY

 

________________________________________________________________

 

 

 

______________________________________________

_______________

 

NAME AND ADDRESS OF FUNERAL HOME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF FUNERAL HOME DIRECTOR

 

 

 

 

 

 

 

LICENSE NUMBER

 

TO THE BEST OF MY KNOWLEDGE, THE ABOVE INFORMATION OF THIS WORKSHEET IS TRUE AND CORRECT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_____________________________________

___________________

 

 

 

______________________________________________

________

 

INFORMANT’S SIGNATURE

 

 

 

 

 

 

 

 

DATE SIGNED

 

 

 

 

 

SIGNATURE OF FUNERAL DIRECTOR

 

 

 

 

 

 

 

 

DATE SIGNED

Created by Maricopa County, V.1.0

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Ways to prepare arizona vsims fillable stage 1

2. Once your current task is complete, take the next step – fill out all of these fields - APTUNIT, STATE, BIRTH STATE, ZIP CODE, CITY, BIRTH COUNTY, BIRTH CITY, RESIDENCE COUNTRY, OTHER SPECIFY UNKNOWN REFUSED NOT, SAMOAN OTHER PACIFIC ISLANDER, DECEDENTS RACE SELECT ALL THAT, DAYS WEEKS MONTHS YEARS HOW LONG, DECEDENTS INDUSTRY, YES NO UNKNOWN ON AZ RESERVATION, and YES NO UNKNOWN US ARMED FORCES with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

How to complete arizona vsims fillable portion 2

Those who work with this form frequently get some points wrong when completing APTUNIT in this section. Ensure you double-check whatever you enter right here.

3. This next part will be hassle-free - fill out every one of the form fields in DECEDENTS RACE SELECT ALL THAT, NAME CITY STATE OF SECOND, LAST NAME, MOTHERS LAST NAME PRIOR TO FIRST, DECEDENTS INDUSTRY, RELATIONSHIP TO DECEASED, REMOVALOTHER SPECIFY , LAST NAME, REMOVALDONATIONENTOMBMENT REMOVAL, MIDDLE NAME, MIDDLE NAME, MIDDLE NAME, YES NO UNKNOWN US ARMED FORCES, COUNTRY IF NOT IN US, and SUFFIX to complete this part.

arizona vsims fillable conclusion process shown (portion 3)

4. To move forward, your next stage requires filling out a handful of fields. These comprise of DECEDENTS RACE SELECT ALL THAT, DATE SIGNED, SIGNATURE OF FUNERAL DIRECTOR, and DATE SIGNED, which are essential to moving forward with this form.

arizona vsims fillable conclusion process clarified (part 4)

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