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To the Informant, who is completing this form:

When you sign or fax this document you are stating that all information is true to the best of your knowledge. Please check all spelling.  This information will be placed on the Death Certificate, changes to the certificate can only be made by amending the original and submitting those changes to the County of San Diego, Office of Vital Statistics and the Death Registration Office, State of California, Sacramento.

Form

Decedent Information:

Informant Information:

Spouse & Parent Information:

Funeral Director's Information:

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