Vital Statistics | Coles Tribute Center | Baker City, OR

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Your Information

Your First Name

Your Last Name

Your Email

Your Phone Number

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Deceased's Information

Step 1 - Vial Statistics of Deceased

First Name of Deceased

Middle Name of Deceased

Last Name of Deceased

Home Address

City

State

Zip Code

Gender

Male

Female

Social Security Number

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Step 2 - Family Information

Spouse/Partner First Name

Spouse/Partner Middle Name

Spouse/Partner Last Name

Spouse/Partner Maiden Name (If Female)

Father's First Name

Father's Middle Name

Father's Last Name

Mother's First Name

Mother's Middle Name

Mother's Last Name

Phone

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Step 3 - Biographical Information

Race (white, black, American Indian, etc.)

Ancestry (American, French, Irish, etc.)

Birth Address

Birth City

Birth State

Birth Zip Code

Birth Date

Age

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Step 4 - Professional History

Occupation (kind of work done most of life, not retired)

Kind of business or industry employed with

Years of education, elementary/secondary

College degree

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Step 5 - Informant (next of kin to contact)

First Name

Middle Name

Last Name

Relationship

Telephone

Telephone Mode

Landline

Cell Phone

Informant Physical Address

City

State

Zip Code

Informant Mailing Address

City

State

Zip Code