Vital Statistics Worksheet Form

The Vital Statistics Worksheet is used to gather the information needed to complete the death certificate which is filed with the county health department. It is advisable to gather this information well in advance of an impending death. Often surviving adult children cannot immediately or easily find important information such as a social security number, the maiden name of a grandparent, or where the decedent’s military papers are located.

After downloading this form, information can be entered by computer using Adobe Reader and printed, or a blank sheet can be printed and filled out by hand.

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Cremation Authorization Facts:

The Cremation Authorization gives the funeral service and crematory the permission to perform the cremation. It may be signed by any competent person on his or her own behalf or it may be signed by the legal authorizing agent after the death has occurred. Under the Washington Administrative Code (WAC 308-47-010) “Authorizing agent” means the person(s) legally entitled to control the disposition of the human remains. The authorizing agent is the competent adult highest on the following list:

1. 1).   The decedent through a pre-need cremation authorization (RCW* 68.50.160);
2. 2).   The surviving spouse of the decedent;
3. 3).   The surviving adult children of the decedent;
4. 4).   The surviving parents of the decedent;
5. 5).   The surviving adult siblings of the decedent;
6. 6).   The surviving adult grandchildren of the decedent;
7. 7).   The surviving adult nephews or nieces of the decedent;
8. 8).   A next closest adult relative of the decedent;
9. 9).   A person acting as a representative of the decedent under the signed authorization of the decedent; or
10. 10). In the absence of any of the above, by order of District Court.

RCW* 68.50.160 states, “A person has the right to control the disposition of his or her own remains without the predeath or post death consent of another person. A valid written document expressing the decedent’s wishes regarding the place or method of disposition of his or her remains, signed by the decedent in the presence of a witness, is sufficient legal authorization for the procedures to be accomplished. Prearrangements that are prepaid, or filed with a licensed funeral establishment or cemetery authority………are not subject to cancellation or substantial revision by survivors.”

RCW 68.50.180 further states that if a funeral establishment or cemetery has made a good faith effort to locate the responsible next of kin, and they cannot be found, ” the cemetery authority or funeral
establishment shall have the right to rely on an authority to cremate executed by the most responsible party available, and the cemetery authority or funeral establishment shall not be criminally or civilly liable for cremating the remains.”

Read RCW 68.50.180 here(Opens in New Window)

An individual may sign his or her own authorization, or a surviving spouse may sign for the decedent, When there are multiple surviving members of any of the above classes (3-7),
it is generally required that all surviving members of that class sign the cremation
authorization, Fax copies are acceptable.

Use The Following Cremation Authorization Form When The Deceased Has Not Pre-signed A Cremation Authorization Prior To Death:

To Be Completed By The Closest Next of Kin - ( See the order of authorizing signatures under "Facts" above)

The following Cremation Authorization Form is used when the decedent did not authorize the cremation pursuant to RWC 68.50.160.

There are three places on the form that require a signature(s):

1. Authorization to Cremate
2. Acknowledgement that the remains of the decedent do or do not contain implants such as pacemakers, radioactive devices, or mechanical devices, and permission to remove dangerous devices prior to cremation.
3. Acknowledgement that the authorizing agent(s) understand how cremation is performed.

This form can be filled out on the computer or printed and filled out by hand. We will need the ORIGINAL SIGNATURE(S).  Please make a copy for records and provide the original to our office.

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Use The Following Cremation Authorization Form When You Are Wanting To Sign YOUR OWN Cremation Authorization:

An individual may sign his or her own Cremation Authorization by law. You may use this form when preplanning your own final arrangements. 

This form can be filled out on the computer or printed and filled out by hand. We will need the ORIGINAL SIGNATURE.  Please make a copy for your records and provide the original to our office.

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Obituary Information form:

This form will help you to create a memorial/obituary for your loved one. The information provided on this form will help Cook Family Funeral Home complete the obituary that will be used on our website as well as in local newspapers. 

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Release of Human Remains Authorization Form:

This form authorizes the release of the human remains and any personal property of the deceased to Cook Family Funeral Home and/or its agents.

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Embalming Authorization Form:

Authorizes Cook Family Funeral Home and/or its agents permission to embalm, and or disinfect, and or preserve for burial and or other disposition of the deceased body.

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Death Certificate Ordering Form:

Kitsap County Health District offers certified copies of deaths occurring in Kitsap County for one year past the date of death. Click on link below to view the order form and instructions.

PLEASE NOTE: Kitsap County Health District no longer accepts personal checks as payment.

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For more information, please call (206)-842-2642 or (360) 779-7872.