Coordinating Completion of the Death Certificate
You will work with the city/town clerk for data entry about the decedent. You do not need to use these older Massachusetts forms, but filling them out in advance could be helpful. We suggest printing a copy of the form and filling it in as best you can.
The following suggestions on filling out the forms were taken from a former “Quick Start Guides for City/Town Clerks.”
Informant Worksheet for Certificate of Death
Name of Decedent. Enter the full legal name. Generational ID is a name suffix, such as “Jr.” Surname at birth or adoption is required of all decedents, male or female, and is commonly known as “maiden” surname. If there is no middle name, check the “No middle name” checkbox.
AKA. If the decedent had aliases (“Also Known As” or “AKA” names), enter the number of names you would like to add.
Pronouncement performed. This field refers only to the manual RN/PA/NP pronouncement form that the family designee may receive, typically in deaths that occur in a residence or nursing home.
Residence. Enter the decedent’s last legal residence address.
Last Spouse. If marital status is anything other than “never married,” you will enter the information for the last known spouse: legal first and last name and surname at birth or adoption, which is required for both males and females (formerly “maiden” surname). Enter middle name if known.
Parents. For each parent, enter the legal first and last names, as well as the surname at birth or adoption, which is required for both males and females (formerly “maiden” surname). Enter middle name if known.
Veteran Status. Answer Y or N. Note that this field is no longer limited to “war” veteran. If yes, then complete the Veteran Information Worksheet and attach it to the Informant Worksheet.
Ethnicity. You must check at least one selection in both the Decedent’s Ethnicity and Decedent’s Race sections, but more than one selection can be made in each column, if applicable. Because it is possible that multiple races will not fit neatly on the death certificate, an additional field, Decedent’s Death Certificate Race, allows the informant to specify how they would like the race to print on the front of the death certificate. All other race and ethnicity information will appear on the reverse of the death certificate.
Decedent’s Education. Choose a category that best represents the decedent’s level of education. If the decedent was not educated in the United States, select the category that most closely reflects the educational level achieved.
Decedent’s Occupation and Industry. Enter detail about the decedent’s latest occupation and industry. Do not enter “retired” or “not working.” Enter “Retired Mechanical Engineer” or “State K-9 Police Officer.”
Veteran Information Worksheet for Certificate of Death
War. Select the most recent war in which the decedent served as a U.S. veteran from the pick-list. If the veteran was a peacetime veteran, choose “Peacetime.” If the conflict is not listed, you may choose “Other” and specify.
Branch of Service. Select the most recent U.S. branch of service in which the veteran served. This field and “War” are the only two required fields for veterans.
Rank/Organization/Outfit. Enter the rank that corresponds to the war entry. If there were more than one rank achieved, enter the highest rank. You may also add any additional information about the veteran’s military organization, detail or outfit.