Death Certificate Template, Sample & Format

Introduction

Death Certificate is a kind of medical certificate which officially declares in a written form about the death of a person and the factors associated with the same. Such a document is prepared by a medical practitioner or other such authorized person of the government. A certificate such as this one serves the significant purpose of examining the cause of death. It also helps the family of the deceased person to register his or her death.

The authorities may require the document for certain legal matters. Therefore, care should be taken to write the content of the certificate clearly, without making grammatical or spelling mistakes of any kind. Important details such as the time of the death, place of the death, date and place of birth of the deceased person,  his or her age, etc., must be mentioned on the certificate. The particulars mentioned must be correct in nature.

The following is a sample of a Death Certificate.

Sample Certificate

Death Certificate

I, Adam Baker, Orthopedic Surgeon at Delmont and Alfred Private Hospital, Australia, hereby, officially document and certify the death of Mr. Thomas K. Figueroa who died at 12.16 p.m. in Delmont and Alfred Private Hospital, Perth, Australia, on the 22nd day of January, 2013.

Mr. Figueroa was born on April 8, 1953 in Alice Springs, Australia and passed away at the age of 60. He was the son of Mr. Kirsten K. Figueroa and was married to Mrs. Maria Figueroa. He had been working as the Operations Director of the organization, F and S Wealth Advisors Limited, located in Wagga Wagga, Australia. Mr. Thomas K. Figueroa died as a result of metastatic bone cancer. The disease was first detected on May 19, 2011, by Dr. Peter Sanger, Orthopedic Surgeon at Bathurst and Coff Private Hospital, Poya, New Caledonia. Mr. Figueroa was admitted to our hospital on July 26, 2011. Very few improvements could be observed in his health and because of improper health habits on part of the patient, his medical condition began to deteriorate further. The immediate cause of his death was recorded to be a sudden increase in the severity of the bone infection.

I declare that each of the above-mentioned particulars is correct and true to the best of my knowledge. This medical certificate is being issued by our medical institution on the specific request of Mrs. Maria Figueroa, wife of late Mr. Figueroa.

Dr. Adam Baker,

Orthopedic Surgeon,

Delmont and Alfred Private Hospital

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