Death Certificate Request Form

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Department of Medical Examiner-Coroner
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Death Certificate Request Form

Post by Department of Medical Examiner-Coroner »

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DEATH CERTIFICATE REQUEST
LOS SANTOS DEPARTMENT OF MEDICAL EXAMINER-CORONER
SPACER
Provide full or partial search input using the following fields:



Full Name: ANSWER
Address: ANSWER
Occupation: ANSWER
Contact Number: ANSWER


(If you are requesting for multiple bodies, you can number them instead of separate topics. EX: John Doe (1), John Doe (2))
Full Name: ANSWER
Gender: ANSWER
Ethnicity: ANSWER
Known Date of Death: DD/MMM/YYYY



Are you a legal relative of the victim?: YES/NO
Explain the nature of your request: FILL HERE IF THE ANSWER ABOVE IS NO


You should fill below in case we cannot find a relevant case in our database.
PK/CK: ANSWER
Exact Date of Death if known: ANSWER
How did they die?: ANSWER

Code: Select all

[divbox=white][center][img]https://i.imgur.com/HNF4Wyu.png[/img][/center]

[center][b][size=170]DEATH CERTIFICATE REQUEST[/size][/b][/center]
[center][size=65]LOS SANTOS DEPARTMENT OF MEDICAL EXAMINER-CORONER[/size][/center]
[color=transparent]SPACER[/color]
[hr][/hr]
[center]Provide [b]full[/b] or [b]partial[/b] search input using the following fields:
[/center]
[hr][/hr]
[br][/br][accordionfixed=1;REQUESTER'S;][color=#535a6c][justify][hr][/hr]
[b]Full Name:[/b] ANSWER
[b]Address:[/b] ANSWER
[b]Occupation:[/b] ANSWER
[b]Contact Number:[/b] ANSWER
[/accordionfixed]

[br][/br][accordionfixed=1;DECEDENT'S;][color=#535a6c][justify][hr][/hr]
[size=85](If you are requesting for multiple bodies, you can number them instead of separate topics. EX: John Doe (1), John Doe (2))[/size]
[b]Full Name:[/b] ANSWER
[b]Gender:[/b] ANSWER
[b]Ethnicity:[/b] ANSWER
[b]Known Date of Death:[/b] DD/MMM/YYYY
[/accordionfixed]
[br][/br][accordionfixed=1;NATURE OF REQUEST;][color=#535a6c][justify][hr][/hr]
[size=85][/size]
[b]Are you a legal relative of the victim?[/b]: YES/NO
[b]Explain the nature of your request:[/b] FILL HERE IF THE ANSWER ABOVE IS NO
[/accordionfixed]
[br][/br][accordionfixed=1; (( OOC DETAILS ));][color=#535a6c][justify][hr][/hr]
You should fill below in case we cannot find a relevant case in our database. 
[b]PK/CK[/b]: ANSWER
[b]Exact Date of Death if known[/b]: ANSWER
[b]How did they die?[/b]: ANSWER
[/accordionfixed][/divbox]

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