Death Certificate CME-Table of Contents

rocedures for Filling Out the Certifier's Portion of a Certificate of Death:

Line-by-Line Instructions (Lines 1-20)
- Line 1-Name of Deceased
- Line 2-Sex of Deceased
- Line 3-Date of Death
- Line 4-Date of Birth
- Line 5-Age
- Line 6-Birth Place
- Line 7-Social Security Number
- Line 8-Race
- Line 9-Hispanic Origin
- Line 10-U.S. Armed Forces
- Line 11-Education
- Line 12-Marital Status
- Line 13-Surviving Spouse
- Line 14-Occupation/Industry
- Line 15-Residence
- Line 16-Father's Name
- Line 17-Mother's Name
- Line 18-Place of Death
- Line 19-Pregnancy
- Line 20-Manner of Death

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