Houston Death Certificates

Houston Death Certificates

STATE OF TEXAS CERTIFICATE OF DEATH WORKSHEET

This information is required to complete the Death Certificate. Incomplete information will delay the filing of the Death Certificate. If you do not know the information write “Unknown”. You will be given a chance to complete the information prior to filing. This is the statement that is on the Death Certificate: WARNING – The penalty for knowingly making a false statement in this form can be 2 -10 years in prison and a fine of up to $10,000. (Health and Safety Code, Sec. 195, 1989)

malefemale
marriedwidoweddivorcednever marriedunknown
yesnounknown
8th grade or less9th - 12th grade,no diplomaHigh School Graduate or GED completed Some College Credit, but no degreeAssociate degree Bachelor’s degree Master’s degree Doctorate
No, not Spanish, Hispanic/LatinoYes, Mexican, Mexican American, ChicanoYes, Puerto RicanYes, Cuban
WhiteBlack or African American
American Indian or Alaska Native (Name of the enrolled or principal tribe)Asian IndianChineseFilipinoJapaneseKoreanVietnameseSamoanOther Asian (Specify)
Native HawaiiGuamanian or ChamorroOther Pacific Islander (Specify)
YesNo
USMCUS ArmyUS Air ForceUS NavyUS Coast Guard
YesNo