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Collects decedent identification and demographics including legal name, sex, age, birth and death dates, birthplace, and place of death details such as hospital or other facility. Captures marital status, spouse information, occupation, residence, U.S. armed forces service, education, Hispanic origin, and race. Includes informant and funeral arrangement fields, disposition method and location, medical certification, cause of death Part I and contributing conditions Part II, autopsy and medical examiner questions, injury information, and required signatures, license details, and registration dates.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/north-carolina-vital-records-certificate-of-death-registration/265400/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/north-carolina-vital-records-certificate-of-death-registration/265400.png","ImageObject",300,407,{"name":92,"@type":93},"Bill Black","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-14",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",21,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What decedent information is requested on this certificate of death registration form?","Question",{"text":113,"@type":114},"The form requests the decedent’s legal name, sex, age, birth and death dates, birthplace, and the place of death (with options such as inpatient, ER/outpatient, nursing home, hospice facility, home, or other). It also includes marital status, surviving spouse name, usual occupation, and business/industry.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How is the cause of death documented on the form?",{"text":118,"@type":114},"Cause of death is recorded in Part I as the chain of events leading directly to death, with an immediate cause section. Part II captures other significant conditions that contribute to death but do not result in the underlying cause listed in Part I. The form instructs not to abbreviate and to provide only one cause per line.",{"name":120,"@type":111,"acceptedAnswer":121},"What items relate to disposition, certification, and registration?",{"text":122,"@type":114},"The form includes informant details, method and place of disposition (burial, cremation, entombment, donation, removal from state, or other), and funeral home/director information. It also requires medical certifier selection (physician/nurse practitioner/physician assistant or medical examiner), signatures, license numbers, dates signed, and state/local registrar registration and file dates.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},265400,1789395272,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":130,"read_time":81},24189269381491,"https://ap-avatar.wpscdn.com/avatar/160000cf11732dd8392?x-image-process=image/resize,m_fixed,w_180,h_180&k=1788146458752108895","NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES  \nN.C. VITAL RECORDS  \nCERTIFICATE OF DEATH  \nREGISTRATION  \nDISTRICT NO.    \nLOCAL NO.  \n_________________  \nSTATE FILE NO.  \n___________________________________  \nDECEDENT’S LEGAL NAME  \n1a. FIRST 1b. MIDDLE 1c. LAST 1d. SUFFIX 1e. LAST NAME PRIOR TO FIRST  \nMARRIAGE  \naka aka aka  \n2. SEX 3a. AGE-LAST 3b. UNDER 1 YEAR 3c. UNDER 1 DAY 4. DATE OF BIRTH (Month/Day/Year) 5. BIRTHPLACE 6. DATE OF DEATH (Month/Day/Year)  \nBIRTHDAY (Yrs) Months Days Hours Minutes (County/State or Foreign Country)  \nPLACE OF DEATH (Check only one)  \n7a. IF DEATH OCCURRED INA HOSPITAL 7b. IF DEATH OCCURRED SOMEWHERE OTHER THANA HOSPITAL  \n􏁯 Inpatient 􏁯 ER/Outpatient 􏁯 DOA 􏁯 Hospice facility 􏁯 Nursing home/Long term care facility 􏁯 Decedent’s home 􏁯 Other (Specify)    \n7c. FACILITY NAME (If not institution, give street and number) 7d. CITY OR TOWN 7e. COUNTY OF DEATH  \nF  \n8. MARITAL STATUS  \n􏁯 Married 􏁯 Married, but separated 􏁯 Widowed  \n􏁯 Divorced 􏁯 Never married 􏁯 Unknown  \n9. SURVIVING SPOUSE (Give name prior to first marriage)  \n10a. DECEDENT’S USUAL OCCUPATION (Do not use retired)  \n10b. KIND OF BUSINESS/INDUSTRY  \nSelect  \n11. SOCIAL SECURITY NUMBER 12a. RESIDENCE–STATE OR FOREIGN COUNTRY 12b. COUNTY 12c. CITY OR TOWN  \n12d. STREET AND NUMBER 12e. INSIDE CITY LIMITS  \n􏁯 Yes 􏁯 No  \n12f. ZIP CODE 13. WAS DECEDENT EVER IN  \nU.S. ARMED FORCES?  \n􏁯 Yes 􏁯 No  \n14. DECEDENT’S EDUCATION (Check the box that best describes the highest degree or level of school completed at the time of death)  \n􏁯 8th grade or less  \n􏁯 9th–12th grade; no diploma  \n􏁯 High school graduate or GED completed  \n􏁯 Some college credit, but no degree  \n􏁯 Associate degree (e.g., AA, AS)  \n􏁯 Bachelor’s degree (e.g. , BA, AB, BS)  \n􏁯 Master’s degree (e.g. , MA, MS, MEng, MEd, MSW, MBA)  \n􏁯 Doctorate (e.g. , PhD, EdD) or Professional degree (e.g. , MD, DDS, DVM, LLB, JD)  \n15. DECEDENT OF HISPANIC ORIGIN? (Check the box that best describes whether the decedent is Spanish/Hispanic/Latino. Check the“No”box if decedent is not Spanish/Hispanic/Latino)  \n􏁯 No, not Spanish/Hispanic/Latino  \n􏁯 Yes, Mexican, Mexican American, Chicano  \n􏁯 Yes, Puerto Rican  \n􏁯 Yes, Cuban  \n􏁯 Yes, other Spanish/Hispanic/Latino (Specify)  \n16. DECEDENT’S RACE (Check one or more races to indicate what the decedent considered himself or herself to be)  \n􏁯 White  \n􏁯 Black or African American  \n􏁯 American Indian or Alaska Native (Name of the enrolled or principal tribe)  \n􏁯 Asian Indian  \n􏁯 Chinese  \n􏁯 Filipino  \n􏁯 Japanese  \n􏁯 Korean  \n􏁯 Vietnamese  \n􏁯 Other Asian (Specify)  \n􏁯 Native Hawaiian  \n􏁯 Guamanian or Chamorro  \n􏁯 Samoan  \n􏁯 Other Pacific Islander (Specify)  \n􏁯 Other (Specify)  \n17. FATHER/PARENT NAME (First, Middle , Last) (Last Name Prior to First Marriage) 18. MOTHER/PARENT NAME (First, Middle , Last) (Last Name Prior to First Marriage)  \n19a. INFORMANT’S NAME 19b. RELATIONSHIP TO DECEDENT 19c. MAILING ADDRESS (Street and Number, City, State, Zip Code)  \n20a. METHOD OF DISPOSITION 􏁯 Burial 􏁯 Cremation  \n􏁯 Donation 􏁯 Entombment 􏁯 Removal from State  \n􏁯 Other (Specify)    \n20b. PLACE OF DISPOSITION (Name of cemetery, crematory, other place)  \n20c. LOCATION (City or Town and State)  \n21a. SIGNATURE OF FUNERAL DIRECTOR 21b. LICENSE NUMBER 21c. NAME OF EMBALMER 21d. LICENSE NUMBER  \n22. NAME AND ADDRESS OF FUNERAL HOME  \n23. Part I. Enter the chain of events (diseases, injuries or complications) that directly caused the death. DO NOT enter terminal events such as cardiac arrest, Approximate interval: respiratory arrest, or ventricular fibrillation without showing the etiology on lines b, c and/or d. Enter only one cause on a line. DO NOT ABBREVIATE. Onset to death  \nIMMEDIATE CAUSE  \nFesinualltiisgeinase ordeathcondition) 􏂮  \nSiflU(ininiiqteistdieEaea,liaYlinlreAliIyneNigGneSlitcECryniioueulsen,g 􏁻  \na.    \nDue to (or as a consequence of)  \nb    \nDue to (or as a consequence of)  \nc.    \nDue to (or as a consequence of)  \nd    \nPART II. Other significant condi","cbCaik0X97O6RAg2","https://ap.wps.com/l/cbCaik0X97O6RAg2","pdf",274081,"English","# Decedent Information\n## Place of Death and Marital Status\n## Residence, Armed Forces, Education, Origin, and Race\n# Death Circumstances and Medical Certification\n## Cause of Death (Part I) and Contributing Conditions (Part II)\n## Autopsy, Manner of Death, Medical Examiner Referral, and Tobacco Use\n## Injury and Certification\n# Funeral and Registration Details\n## Informant and Disposition\n## Funeral Home and Director Information\n## Signatures, Licenses, and Registration Dates","[{\"question\":\"What decedent information is requested on this certificate of death registration form?\",\"answer\":\"The form requests the decedent’s legal name, sex, age, birth and death dates, birthplace, and the place of death (with options such as inpatient, ER/outpatient, nursing home, hospice facility, home, or other). It also includes marital status, surviving spouse name, usual occupation, and business/industry.\"},{\"question\":\"How is the cause of death documented on the form?\",\"answer\":\"Cause of death is recorded in Part I as the chain of events leading directly to death, with an immediate cause section. Part II captures other significant conditions that contribute to death but do not result in the underlying cause listed in Part I. The form instructs not to abbreviate and to provide only one cause per line.\"},{\"question\":\"What items relate to disposition, certification, and registration?\",\"answer\":\"The form includes informant details, method and place of disposition (burial, cremation, entombment, donation, removal from state, or other), and funeral home/director information. It also requires medical certifier selection (physician/nurse practitioner/physician assistant or medical examiner), signatures, license numbers, dates signed, and state/local registrar registration and file dates.\"}]","North Carolina Vital Records - Certificate of Death Registration | PDF"]