This category includes the deceased name, sex, age, Social Security number, date of birth, birthplace, date of death, place of death (including the name of the institution or street address of the deceased’s home and whether deceased was an inpatient, dead on arrival, or emergency (if death was in a hospital), municipality and county where death occurred (some states require information on whether the death was within city limits), deceased’s occupation (do not specify “retired”), kind of business or industry in which the deceased worked, and in some states, the place of the deceased’s employment.
Also included is U.S. military service, marital status (married, never married, divorced, widowed), spouse’s name, deceased’s residence (including house number and street, city, country, and state), deceased’s race (most states require information on whether the deceased was Hispanic and, if so, what nationality), deceased’s educational level, names of the deceased's parents including mother’s maiden name (some states also require information on parents’ places of birth), name of the person who informed authorities of the death, and, in some states, deceased’s country of citizenship.
Information on Disposition
This category includes method of disposition (burial, cremation, mausoleum, removal from state, or donation), place of disposition (name of cemetery, crematory or other location), city and state in which the place of disposition is located, funeral director’s signature and license number (some states require the embalmer’s signature and license number, as well), name and address of the respective funeral home and occasionally the funeral home’s license number.
Cause of Death
This category usually requires completion by the certifying physician and includes immediate cause of death, information on the manner of death (natural, accidental, suicide, homicide or undetermined), and whether the manner of death is cause for legal intervention or is pending investigation. If death is caused by an accident, information is also required on the date, time and place of the injury, and a description of how the accident occurred.
Where to Write for Death Certificates
State of Connecticut
Department of Public Health and Addiction Services
Vital Records Section
150 Washington Street
Hartford, CT 06106