Death Certificate Worksheet – Fill Out and Use This PDF

Updated: Nov 10, 2026

The Death Certificate Worksheet is a standardized form used in Illinois to collect essential information regarding a deceased individual. It covers a wide range of details from basic identifiers like name and birthdate to more specific data, including marital status, military service, and method of disposition. To ensure all relevant details are accurately recorded for official death certificates, carefully completing this form is crucial. Click the button below to fill out the form.

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Death Certificate Worksheet PDF Details

When someone passes away, a crucial step in the process involves the completion of the Death Certificate Worksheet form, a document that captures essential information about the deceased. Specially designed for use in Illinois, this form requires careful attention to detail and accuracy as it asks for comprehensive details including but not limited to the name of the deceased, date and place of death, age, date of birth, and social security number. It delves into personal history, noting marital status, birthplace, and if the deceased ever served in the U.S. Armed Forces. The form not only seeks information pertaining to the deceased but also about the informant and the next of kin, alongside specifics about the method and place of disposition of the remains, whether through burial, cremation, donation, or entombment. Recognizing the diversity of the population, it inquires about the decedent's education level, Hispanic origin, race, and usual occupation, thus painting a detailed demographic and socio-economic picture. This information is not only vital for official records and statistics but also aids families in finalizing the deceased's affairs, including the need for multiple copies of the death certificate for various administrative purposes. Comprehending the significance and the depth of information required by the Death Certificate Worksheet ensures a smoother transition through this challenging period for those left behind.

Question	Answer
Form Name	Death Certificate Worksheet
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	illinois death certificate worksheet, sample of burial certificate, burial certificate, burial certificate sample

How to Fill Out Illinois Death Certificate Worksheet

Illinois Death Certificate Worksheet at a glance

What it is: The Illinois Death Certificate Worksheet is a form to print or type with the name of deceased.

A filled-in Illinois Death Certificate Worksheet example: a funeral director records a death

Illinois Death Certificate Worksheet example filled out, example: a funeral director records a death — Mara Sample, a funeral director, fills out the death certificate worksheet. She records the death of a married man at a hospital and chooses cremation. The picture shows the filled worksheet; its names and figures are sample values. The surviving spouse is his wife, so her full name prior to first marriage goes in the spouse field. He lived at the home address in a city, so the address fields are filled. The decedent is not Spanish/Hispanic/Latino and his race is White, so No and White are ticked. The other methods of disposition stay empty because only one method applies.

How to fill out Illinois Death Certificate Worksheet, box by box

The deceased and the death

Print or type the NAME OF DECEASED.

Enter the DATE OF DEATH and the COUNTY OF DEATH.

Enter the AGE and the DATE OF BIRTH.

Enter the CITY OR TOWN OF DEATH and the HOSPITAL OR INSTITUTION NAME.

Enter the BIRTHPLACE and the SOCIAL SECURITY NUMBER.

Marital status and surviving spouse

Enter the MARITAL STATUS AT TIME OF DEATH.

Enter the SURVIVING SPOUSE'S NAME. If wife, give full name prior to first marriage.

Mark YES or NO for EVER IN U.S. ARMED FORCES?

Home address of the deceased

Enter the HOME ADDRESS OF DECEASED.

Enter the CITY and mark YES or NO for INSIDE CITY LIMITS?

Enter the COUNTY, the STATE and the ZIP CODE.

Father's name, mother's name, informant and mailing address

Enter the FATHER'S NAME and the MOTHER'S NAME PRIOR TO FIRST MARRIAGE, each as First, middle, last.

Enter the INFORMANT'S NAME and the RELATIONSHIP TO DECEDENT.

Enter the MAILING ADDRESS as Street & No., City or Town, Zip Code.

Method of disposition

Mark the METHOD OF DISPOSITION: Burial, Cremation, Donation or Entombment.

Enter the PLACE OF DISPOSITION as the Name of cemetery, crematory, other, and the LOCATION as City, Town & State.

Enter the DATE OF DISPOSITION and the DECEDENT'S EDUCATION LEVEL as the Highest grade completed.

Hispanic origin

For DECEDENT OF HISPANIC ORIGIN?, check the one that best describes whether the decedent is Spanish/Hispanic/Latino. Check “No” if decedent is not Spanish/Hispanic/Latino.

Check No, not Spanish/Hispanic/Latino; Yes, Mexican, Mexican American, Chicano; Yes, Puerto Rican; Yes, Cuban; or Yes, Other Spanish/Hispanic/Latino Specify.

Decedent's race

For DECEDENT'S RACE, check one or more races to indicate what the decedent considered himself or herself to be.

Check White, Black or African American, American Indian, Chinese, Filipino, Japanese, Korean, Vietnamese or Other Asian (Specify).

Check Native Hawaiian, Guamanian or Chamorro, Samoan, Other Pacific Islander (Specify) or Other (Specify).

Occupation, industry and number of certificates

Enter the DECEDENT'S USUAL OCCUPATION and the TYPE OF INDUSTRY.

Enter how many death certificates will you need.

Sources

[1] Illinois Death Certificate Worksheet, as served on formspal.com (the Official source link on this page).