Homepage Blank Michigan Death Certificate PDF Form
Article Guide

The Michigan Death Certificate form is a crucial document that serves multiple purposes in the aftermath of a person's passing. It captures essential details about the deceased, such as their name, date of birth, and date of death, as well as information regarding their residence and family background. The form also includes sections for the certifying physician to indicate the cause of death, ensuring accurate medical documentation. Additionally, it allows for the specification of the method of disposition, whether through burial, cremation, or other means. Understanding the requirements of this form is vital, as any omissions or inaccuracies can lead to complications, such as the designation of “UNKNOWN” for any unanswered items. The form is structured to facilitate the collection of information from various sources, including the funeral home, family members, and medical professionals. It is important to note that the process may vary depending on whether standard or expedited services are selected, with the latter providing a quicker turnaround for obtaining certified copies. Ultimately, this document not only fulfills legal obligations but also serves as a vital record for the deceased's family and estate. Proper completion of the Michigan Death Certificate is essential to ensure that all necessary details are accurately recorded and filed with the appropriate authorities.

Document Preview

Jansen Family Funeral Home 4705 Pine Street / PO Box 77 Columbiaville, MI 48421 Daniel L. Jansen, Manager / Owner

www.jansenprofessionalservices.com Phone 810-793-6234

Michigan Death Certificate

Please Use the attached PDF of a Michigan Death Certificate to obtain the needed vitals to complete a death certificate. Please return this with DC Information. Fax 810-793-4752

How Many Death Certificates are Needed ? _____________

** Don’t assume a FREE veterans copy will be provided by all clerks offices.

Cremation

Yes

No

 

SELECT ONE

Standard Service

Expedited Service

Standard

- DC is completed 1-3 weeks. This service is provided in our standard

 

cost already. Dc’s mailed to your funeral home.

Expedited

- An individual is placed on your DC till it is completed.

 

1 Week Max

( $40 Extra ) This Service is included in all

 

Direct Cremations already. Dc’s mailed to your funeral home.

Important Notes:

Item 8C - Please check on this item in order to insure accuracy.

This is not always the city listed in the mailing address.

Our funeral home will obtain the place of death, date of death, and time of death. Items - 4, 7A, 7B, 7C, 28A, 28B, 28C, 29, 30, 31, 39, 40A

Any item left blank will be listed on the certificate as “UNKNOWN”

A Proof will be faxed before Dc is filed at clerks office.

If you want Dc’s mailed to another location - Please advise us of the change

TYPE/PRINT

 

 

STATE OF MICHIGAN

IN

 

 

 

 

 

PERMANENT

LF

 

 

BLACK INK

 

DEPARTMENT OF COMMUNITY HEALTH

CF

 

CERTIFICATE OF DEATH

 

 

 

 

 

STATE FILE NUMBE

DECEDENT

DECEDENT

physician or institution

NAME OF

For use by

 

PARENTS

 

INFORMANT

DISPOSITION

CERTIFICATION

 

1. DECEDENT'S NAME (First Middle Last)

 

 

 

 

 

 

 

 

 

 

 

 

2. DATE OF BIRTH (Month Day Year)

 

 

3. SEX

4. DATE OF DEATH (Month Day Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. NAME AT BIRTH OR OTHER NAME USED FOR PERSONAL BUSINESS (include AKA's if any)

 

 

 

 

 

 

6a. AGE - Last Birthday

 

 

6b.

UNDER 1 YEAR

 

 

 

 

6c.

UNDER 1 DAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Years)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7a. LOCATION OF DEATH (Enter place officially pronounced dead in 7a 7b

7c)

 

 

 

 

 

7b. CITY, VILLAGE, OR TOWNSHIP OF DEATH

 

 

 

7c. COUNTY OF DEATH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOSPITAL OR OTHER INSTITUTION - Name (if not in either give street and number and zip code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8a. CURRENT RESIDENCE -

 

8b. COUNTY

 

 

8c. LOCALITY - (check the box that describes the location)

 

 

 

 

8d. STREET AND NUMBER (Include Apt. No. if applicable)

 

 

STATE

 

 

 

 

 

 

 

 

 

 

 

 

CITY OR VILLAGE

 

TOWNSHIP

 

UNINCORPORATED PLACE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(inside limits of)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8w. ZIP CODE

 

 

9. BIRTHPLACE (City and State or Country)

 

 

 

 

 

 

 

 

 

 

 

 

10. SOCIAL SECURITY NUMBER

 

11. DECEDENT'S EDUCATION - What is the highest

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

degree or level of school completed at the time of death?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. RACE - American Indian, White, Black, etc. if Asian

give nationality

 

 

13a. ANCESTRY - Mexican, Cuban, Arab, African, English, French, Dutch, etc.

 

 

 

 

 

 

13b. HISPANIC ORIGIN

 

 

14. WAS DECEDENT EVER IN

 

 

ie. Chinese Filipino Asian Indian etc.) (Enter all that apply)

 

 

(Enter all that apply) If American Indian race, enter principal tribe

 

 

 

 

 

 

 

 

 

(Yes or No)

 

 

 

 

 

THE U.S. ARMED FORCES?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(yes or no)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. USUAL OCCUPATION Give kind of work done

 

 

16. KIND OF BUSINESS OR INDUSTRY

 

 

 

17. MARITAL STATUS - Married,

18. NAME OF SURVIVING SPOUSE (if wife

give name before

 

 

during most of working life. Do not use retired.

 

 

 

 

 

 

 

 

 

 

 

 

 

Never Married, Widowed, Divorced

 

 

first married)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19. FATHER'S NAME (First Middle Last)

 

 

 

 

 

 

 

 

 

 

 

20. MOTHER'S NAME BEFORE FIRST MARRIED

(First Middle Last)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21a. INFORMANT'S NAME (Type/Print)

 

 

 

 

 

 

21b. RELATIONSHIP TO

 

21c. MAILING ADDRESS (Street and Number or Rural Route Number City or Village State Zip Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DECEDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22. METHOD OF DISPOSITION

 

23a. PLACE OF DISPOSITION (Name of Cemetery Crematory or other location)

 

 

 

 

 

 

 

 

 

23b. LOCATION - City or Village, State

 

 

 

 

 

Burial Cremation Entombment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Donation Removal Storage

(Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24. SIGNATURE OF MORTUARY SCIENCE LICENSEE

 

25. LICENSE NUMBER

26. NAME AND ADDRESS OF FUNERAL FACILITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(of Licensee)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27a. CERTIFIER (Check only one)

 

 

 

 

 

 

 

 

 

 

 

 

28a. ACTUAL OR PRESUMED

 

 

28b. PRONOUNCED DEAD ON

 

 

 

28c. TIME PRONOUNCED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Certifying Physician - To the best of my knowledge, death occurred due to the cause(s) and

 

TIME OF DEATH

M

(Mo. Day Yr.)

 

 

 

 

 

 

 

 

DEAD

 

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

manner stated.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical Examiner - On the basis of examination, and/or investigation, in my opinion, death

29. MEDICAL EXAMINER

 

30. PLACE OF DEATH (Home, Hospice,

 

31. IF HOSPITAL, Inpatient, Outpatient,

 

 

occurred at the time, date, and place, and due to the cause(s) and manner stated.

 

 

 

 

 

 

 

CONTACTED? (Yes or No)

 

Nursing Home, Hospital, Ambulance) (Specify)

 

 

Emergency Room, DOA (Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature and Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27b. DATE SIGNED (Mo. Day Yr.)

 

 

 

27c. LICENSE NUMBER

32. MEDICAL EXAMINER'S CASE

 

 

33. NAME OF ATTENDING PHYSICIAN IF OTHER THAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NUMBER (if applicable)

 

 

 

 

CERTIFIER (Type or Print)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

34. NAME AND ADDRESS OF CERTIFYING PHYSICIAN (Type or Print)

35a. REGISTRAR'S SIGNATURE

35b. DATE FILED (Month Day Year)

CAUSE OF DEATH

MEDICAL EXAMINER

36. PART I. Enter the chain of events - diseases, injuries, or complications - that directly caused the death. DO NOT enter terminal events such as cardiac arrest, respiratory arrest,

 

 

 

 

Approximate

 

 

 

 

Interval Between

or ventricular fibrillation without showing the etiology. Enter only one cause on a line.

 

 

 

 

 

 

 

 

 

 

_____________________________

 

 

 

 

 

 

 

 

 

 

Onset and Death

 

 

d.

 

 

 

 

 

 

 

 

 

 

If diabetes was an immediate,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

underlying or contributing

a.

 

 

 

 

 

 

 

 

 

 

 

 

 

cause of death be sure to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

record diabetes in either Part I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or Part II of the cause of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

death section, as appropriate.

b.

 

 

 

 

 

 

 

 

 

 

 

 

 

IMMEDIATE CAUSE (Final

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

disease or condition

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

resulting in death)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sequentially list conditions,

c.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF ANY leading to the cause

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

listed on line a. Enter the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNDERLYING CAUSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(disease or injury that

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37. DID TOBACCO USE

 

38. IF FEMALE

 

 

 

initiated the events resulting

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

in death) LAST

 

 

 

 

 

 

 

 

CONTRIBUTE TO DEATH?

 

 

 

 

PART II. OTHER SIGNIFICANT CONDITIONS contributing to death but not resulting in the underlying cause given in Part I.

 

 

 

 

 

Yes

Probably

Not pregnant within past year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

Unknown

Pregnant at time of death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Not pregnant, but pregnant within 42 days of death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

39. MANNER OF DEATH - Accident, Suicide, Homicide,

40a. WAS AN AUTOPSY

40b. WERE AUTOPSY FINDINGS AVAILABLE

 

Not pregnant, but pregnant 43 days to 1 year

Natural, Indeterminate or Pending (Specify)

PERFORMED?

PRIOR TO COMPLETION OF CAUSE OF

 

 

before death

 

 

 

 

 

 

 

 

 

(Yes or No)

DEATH? (Yes or No)

 

 

Unknown if pregnant within the past year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

41a. DATE OF INJURY

 

 

 

41b. TIME OF INJURY

41c. DESCRIBE HOW INJURY OCCURRED

 

 

 

 

 

 

(Mo. Day Yr.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

41d. INJURY AT WORK

41e. PLACE OF INJURY - At home,

41f. IF TRANSPORTATION

 

41g. LOCATION - Street or RFD No.

 

City, Village or Twp.

State

(Yes or No)

farm, street, construction site,

INJURY - Driver/Operator,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

wooded area, etc. (Specify)

Passenger, Pedestrian, etc. (Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form Specifications

Fact Name Details
Governing Law The Michigan Death Certificate is governed by the Michigan Public Health Code, Act 368 of 1978.
Form Provider The form is provided by Jansen Family Funeral Home, located in Columbiaville, MI.
Completion Time Standard service for completing the death certificate takes 1-3 weeks.
Expedited Service An expedited service is available for an additional fee of $40, completing the certificate within 1 week.
Proof Review A proof of the death certificate will be faxed for review before filing with the clerk's office.
Blank Items If any item on the form is left blank, it will be marked as “UNKNOWN” on the certificate.
Veterans Copies Not all clerk's offices provide free copies for veterans; this should not be assumed.

Michigan Death Certificate: Usage Guidelines

Filling out the Michigan Death Certificate form requires careful attention to detail to ensure that all necessary information is accurately recorded. Once the form is completed, it will be submitted to the appropriate authorities for processing. Below are the steps to guide you through the completion of the form.

  1. Begin by entering the Decedent's Name in the format of First, Middle, and Last.
  2. Provide the Date of Birth using the format Month, Day, Year.
  3. Indicate the Sex of the decedent.
  4. Fill in the Date of Death in the same format as the date of birth.
  5. List the Name at Birth or any other name used for personal business, including any aliases.
  6. Enter the Age at the last birthday, and check the appropriate boxes if the decedent was under 1 year or under 1 day old.
  7. Provide the Location of Death, including the officially pronounced place of death.
  8. Fill in the City, Village, or Township of Death.
  9. Specify the County of Death.
  10. For the Current Residence, enter the address, including street number and apartment number if applicable.
  11. List the Birthplace including the city and state or country.
  12. Provide the Social Security Number of the decedent.
  13. Indicate the Decedent's Education level at the time of death.
  14. Specify the Race of the decedent.
  15. Provide details about Ancestry and check if the decedent has Hispanic Origin.
  16. Indicate whether the decedent was ever in the U.S. Armed Forces.
  17. List the Usual Occupation and the Kind of Business or Industry where the decedent worked.
  18. Specify the Marital Status of the decedent.
  19. Provide the Name of Surviving Spouse, if applicable.
  20. Enter the names of the Father and Mother of the decedent.
  21. Fill in the Informant's Name, their Relationship to the Decedent, and Mailing Address.
  22. Specify the Method of Disposition (e.g., Burial, Cremation).
  23. Provide the Place of Disposition and its Location.
  24. Include the Signature of Mortuary Science Licensee and their License Number.
  25. Complete the section regarding the Cause of Death, detailing the chain of events leading to death.
  26. Indicate if a Medical Examiner was contacted and provide their details.
  27. Fill in the Date Filed and the Registrar's Signature.

Your Questions, Answered

What is a Michigan Death Certificate?

A Michigan Death Certificate is an official document that records the details surrounding a person's death. It includes vital information such as the decedent's name, date of birth, date of death, place of death, and cause of death. This certificate is essential for legal purposes, including settling estates and claiming benefits.

How many death certificates should I request?

The number of death certificates you need can vary based on your circumstances. It's advisable to request multiple copies, especially if you need to deal with various institutions like banks, insurance companies, or government agencies. Keep in mind that some clerks' offices may not provide a free copy for veterans, so plan accordingly.

What is the difference between standard and expedited service?

Standard service typically takes 1 to 3 weeks to complete, and the death certificates will be mailed to your funeral home. Expedited service, on the other hand, ensures that the individual is prioritized, and the certificate is completed within one week for an additional fee of $40. This expedited option is included in all direct cremations.

What information is required on the death certificate?

Key information includes the decedent's full name, date of birth, date of death, place of death, and social security number. Additional details such as marital status, parents' names, and the decedent's occupation are also needed. Ensure that all fields are filled out accurately to avoid any "UNKNOWN" listings on the certificate.

Can I have the death certificates mailed to a different address?

Yes, if you would like the death certificates mailed to an address other than the funeral home, you should inform the funeral home of this change when you submit the necessary information. Make sure to provide the complete mailing address to avoid any delays.

What happens if I leave an item blank on the form?

If any item is left blank on the death certificate form, it will be marked as "UNKNOWN" on the final certificate. To ensure accuracy, double-check all entries before submission. The funeral home will provide a proof of the certificate for your review before it is filed with the clerk's office.

How can I contact the funeral home for assistance?

You can reach Jansen Family Funeral Home at 810-793-6234 for any questions or assistance regarding the death certificate process. They are located at 4705 Pine Street, PO Box 77, Columbiaville, MI 48421. Feel free to visit their website at www.jansenprofessionalservices.com for more information.

Common mistakes

  1. Assuming the number of copies needed: Many people mistakenly assume they only need one copy of the death certificate. It's essential to consider that multiple copies may be required for various legal and financial matters.

  2. Neglecting to check Item 8C: Failing to verify the locality of death can lead to inaccuracies. The city listed in the mailing address may not always be the correct place of death.

  3. Leaving items blank: Any blank item will automatically be marked as “UNKNOWN” on the certificate. Ensure that all applicable fields are filled out completely to avoid this issue.

  4. Using incorrect ink: The form specifically requires the use of permanent black ink. Using any other color or type of ink may result in delays or rejections.

  5. Not providing accurate dates: Mistakes in entering the date of birth or date of death can have serious implications. Double-check these dates for accuracy.

  6. Failing to include all names: It’s crucial to list the decedent's full name, including any aliases. Omitting this information can lead to complications.

  7. Incorrectly identifying the informant: The informant’s name and relationship to the decedent must be accurate. Errors here can cause confusion and delays.

  8. Not specifying the method of disposition: Clearly indicate whether the body will be buried, cremated, or donated. This information is essential for proper processing.

  9. Overlooking the need for a signature: The death certificate must be signed by the appropriate parties. Failing to provide the necessary signatures can result in the document being invalidated.

Documents used along the form

When dealing with the death of a loved one, various forms and documents accompany the Michigan Death Certificate. Each document serves a specific purpose and is often necessary for legal, financial, or administrative reasons. Below is a list of commonly used forms that may be required alongside the death certificate.

  • Affidavit of Heirship: This document identifies the heirs of the deceased and is often used when settling estates without a will. It helps establish who is entitled to inherit the deceased's assets.
  • Will: If the deceased left a will, it outlines their wishes regarding asset distribution and guardianship of dependents. It is crucial for probate proceedings.
  • Power of Attorney: This document designates an individual to make decisions on behalf of the deceased in matters such as financial and legal affairs, if applicable.
  • Funeral Home Contract: This agreement details the services provided by the funeral home, including costs and arrangements made for the burial or cremation.
  • Insurance Policies: Life insurance policies may need to be submitted to claim benefits for the deceased's beneficiaries. This is essential for financial planning after death.
  • Social Security Notification: A form is often required to notify the Social Security Administration of the death, which may affect benefits for surviving family members.
  • Medical Examiner's Report: If an autopsy was performed, this report provides details about the cause of death, which may be necessary for insurance claims or legal matters.
  • Transfer Permit: Required for the transfer of remains, this document is issued by the local health department and is essential for cremation or burial.

Understanding these documents and their functions can simplify the process during a challenging time. It is advisable to consult with a legal or funeral professional to ensure that all necessary paperwork is completed accurately and promptly.

Similar forms

Understanding the Michigan Death Certificate can be enhanced by recognizing its similarities with other important documents. Here’s a list of ten documents that share common elements with the Michigan Death Certificate, highlighting how they are alike:

  • Birth Certificate: Like a death certificate, a birth certificate records vital information about an individual, including their name, date of birth, and place of birth. Both documents serve as official records of significant life events.
  • Marriage Certificate: This document, similar to a death certificate, verifies a significant life event and includes details such as the names of the parties involved, the date, and the location of the marriage.
  • Divorce Decree: A divorce decree, much like a death certificate, is a legal document that formalizes the end of a marriage. It includes pertinent information such as the names of both parties and the date of the divorce.
  • Will: A will outlines an individual’s wishes regarding the distribution of their estate after death. Similar to a death certificate, it is a crucial document that comes into play after a person's passing.
  • Power of Attorney: This document grants someone the authority to act on another’s behalf in legal matters. Like a death certificate, it is significant in managing affairs, especially when the individual is incapacitated or deceased.
  • Social Security Card: The social security card, akin to a death certificate, contains essential personal information, including the individual's name and social security number, which is often required for processing a death certificate.
  • Medical Records: Medical records provide information about an individual's health history and can include details relevant to the cause of death, similar to the medical information recorded on a death certificate.
  • Insurance Policy: An insurance policy outlines coverage details for the insured individual. In the event of death, the policy becomes critical, much like the death certificate, to claim benefits.
  • Tax Returns: Tax returns document an individual's income and financial status. They can be necessary for settling an estate after death, paralleling the role of a death certificate in legal and financial matters.
  • Military Discharge Papers: These documents provide evidence of a veteran's service and can be required for benefits after death, similar to how a death certificate is used to process claims and arrangements.

Recognizing these similarities can help individuals understand the importance of the Michigan Death Certificate in the broader context of legal and vital records.

Dos and Don'ts

When filling out the Michigan Death Certificate form, it is essential to follow specific guidelines to ensure accuracy and completeness. Here are five things to do and five things to avoid:

  • Do use permanent black ink when completing the form.
  • Do double-check all vital information, such as the decedent's name, date of birth, and date of death.
  • Do ensure that no fields are left blank, as this will result in "UNKNOWN" being listed on the certificate.
  • Do provide accurate information about the location of death and the decedent's residence.
  • Do confirm the number of death certificates needed before submitting the form.
  • Don't assume that a free veterans copy will be provided by all clerk's offices.
  • Don't use abbreviations or nicknames for the decedent's name.
  • Don't forget to include the informant's relationship to the decedent.
  • Don't neglect to specify the method of disposition, such as burial or cremation.
  • Don't submit the form without reviewing it for any errors or omissions.

Misconceptions

Here are eight common misconceptions about the Michigan Death Certificate form:

  • All clerks provide free veterans copies. Not all clerks' offices offer a free copy for veterans. Always check with your local office.
  • Only one death certificate is necessary. Depending on your needs, you may require multiple copies. It's wise to assess how many you will need.
  • All information is optional. Leaving any item blank will result in it being marked as “UNKNOWN.” Complete all fields to avoid this issue.
  • Expedited service guarantees immediate processing. While expedited service speeds up the process, it still requires a maximum of one week for completion.
  • The mailing address is always the place of death. Ensure you verify the location of death, as it may differ from the mailing address.
  • Only medical personnel can complete the form. Family members or informants can provide information, but accuracy is crucial.
  • Signing the form is the final step. A proof will be faxed to you before the death certificate is filed, allowing for corrections if needed.
  • Race and ancestry are the same. These are distinct categories on the form. Provide accurate information for both to ensure proper documentation.

Key takeaways

Filling out the Michigan Death Certificate form requires attention to detail and accuracy. Here are key takeaways to keep in mind:

  • Use the provided PDF: Always refer to the attached PDF of the Michigan Death Certificate for the necessary information.
  • Determine the number of copies needed: Assess how many death certificates are required for your purposes. Note that a free veterans copy may not be available from all clerks' offices.
  • Choose the service type: You can select between standard service, which takes 1-3 weeks, or expedited service, completed in a week for an additional fee.
  • Check for accuracy: Pay special attention to Item 8C to ensure the correct city of death is listed, as it may differ from the mailing address.
  • Complete all items: Leaving any item blank will result in it being marked as “UNKNOWN” on the certificate. Ensure all required fields are filled out.
  • Provide correct mailing information: If you need the death certificates sent to a different location, clearly communicate this to the funeral home.

By following these guidelines, you can ensure a smoother process when handling the Michigan Death Certificate form.