Registration of Death Details
Name of deceased______________________________________________________________________________________
Name at birth (if different)______________________________________________________________________________________
Date of death_________________________________________________________________ Sex – female / male
Place of death_________________________________________________________________________________________
Date of birth__________________________________________________________________Age now ______
Place of birth________________________________________________________________Years in NZ________
Address____________________________________________________________________________________________________________
Occupation__________________________________________________________________________________________________________________
Ethnic Group/s
NZ Maori
NZ European / Pakeha
Samoan
Cook Island Maori
Dutch
Tongan
Was Deceased person descended from NZ Maori?
English
Australian
Scottish
Niuean
Tokelauan
other___________________
Yes
Irish
No
Children
Age of each living son______________________________________________________________________________________________________
Age of each living daughter_______________________________________________________________________________________________
Parents
Father’s full name__________________________________________________________________________________________________________
Surname at birth if different____________________________________________Occupation___________________________________
Mother’s full name_________________________________________________________________________________________________________
Surname at birth if different____________________________________________Occupation___________________________________
Marital Details
Married
Civil Union
De Facto
Widowed
Divorced
Separated
Never Married
1)Age of Deceased at marriage/CU______________Place of marriage / CU_______________________________________________
Name of spouse / partner ____________________________________________________________________Age at present________
2)Age of Deceased at marriage/CU______________Place of marriage / CU_______________________________________________
Name of previous spouse / partner __________________________________________________________Age at present________
Was the Deceased a marriage celebrant? No Yes
Was the Deceased a Justice of the Peace? No Yes
Did the Deceased hold an honour or award? No Yes_________________________________________________________________