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PDFWAC 246-491-149

Information collected on the legal or public section of vital records.

The department shall collect the following items on the legal or public section of reports for registration into the statewide vital records system in accordance with chapter 70.58A RCW and this section.
REPORT OF LIVE BIRTH
Table 3:
Legal or Public Birth Record Items
Item Name
Difference from U.S. Standard, if any
Child's name
 
Child's date of birth
 
Time of birth
 
Type of birthplace
Add "En route," Add "Planned birthplace if different"
Child's sex
 
Name of facility
 
City, town or location of birth
 
County of birth
 
Mother/Parent's name before first marriage
 
Mother/Parent's date of birth
 
Mother/Parent's birthplace
 
Mother/Parent's Social Security number
 
Mother/Parent's current legal last name
 
Social Security number requested for child?
 
Mother/Parent's residence - Number, street, and Apt. No.
 
Mother/Parent's residence - City or town
 
Mother/Parent's residence - County
 
Tribal reservation name (if applicable)
Added
Mother/Parent's residence - State or foreign country
 
Mother/Parent's residence - Zip code + 4
 
Mother/Parent's residence - Inside city limits?
 
Telephone number
Added
How long at current residence?
Added
Mother/Parent's mailing address, if different
 
Father/Parent's current legal name
 
Father/Parent's date of birth
 
Father/Parent's birthplace
 
Father/Parent's Social Security number
 
Certifier name and title
Delete check boxes
Date certified
 
Attendant name and title
Delete check boxes
NPI of person delivering the baby
 
REPORT OF FETAL DEATH
Table 4:
Legal or Public Fetal Death Record Items
Item Name
Difference from U.S. Standard, if any
Name of fetus
 
Sex
 
Date of delivery
 
Time of delivery
 
Type of birthplace
Add "En route," Add "Planned birthplace if different"
Name of facility
 
Facility ID (NPI)
 
City, town or location of birth
 
Zip code of delivery
 
County of birth
 
Mother/Parent's name before first marriage
 
Mother/Parent's date of birth
 
Mother/Parent's current legal last name
 
Mother/Parent's birthplace
 
Mother/Parent's residence - Number, street, and Apt. No.
 
Mother/Parent's residence - City or town
 
Mother/Parent's residence - County
 
Tribal reservation name (if applicable)
Added
Mother/Parent's residence - State or foreign country
 
Mother/Parent's residence - Zip code + 4
 
Mother/Parent's residence - Inside city limits?
 
How long at current residence?
Added
Father/Parent's current legal name
 
Father/Parent's date of birth
 
Father/Parent's birthplace
 
Name and title of person completing the report
 
Date report completed
 
Attendant name and title
Delete check boxes
NPI of person delivering the baby
 
Method of disposition
 
Date of disposition
 
Place of disposition
Added
Location of disposition - City/town and state
Added
Name and complete address of funeral facility
Added
Funeral director signature
Added
Initiating cause/condition (cause of death)
 
Other significant causes or conditions
 
Estimated time of fetal death
 
Was an autopsy performed?
 
Was a histological placental examination performed?
 
Were autopsy or histological placental examination results used in determining the cause of death?
 
Registrar signature
Added
Date received
 
REPORT OF DEATH
Table 5:
Death Record Items
Item Name
Difference from U.S. Standard, if any
Legal name (include a.k.a. if any)
 
Death date
 
Sex
Add "X" as nonbinary option
Age - Years
 
Age - Under 1 year
 
Age - Under 1 day
 
Social Security number
 
County of death
 
Birth date
 
Birth place - City, town or county
 
Birth place - State or foreign country
 
Decedent's education
Add "Specify": next to box for "8th Grade or less"
Decedent's Hispanic origin
 
Decedent's race
 
Was decedent ever in U.S. Armed Forces?
 
Residence - Number and street
 
Residence - City or town
 
Residence - County
 
Tribal reservation name (if applicable)
Added
Residence - State or foreign country
 
Residence - Zip code
 
Inside city limits?
 
Estimated length of time at residence
Added
Marital status at time of death
 
Surviving spouse's name
 
Occupation
 
Kind of business/industry
 
Father/Parent's name
 
Mother/Parent's name before first marriage
 
Informant - Name
 
Informant - Relationship to decedent
 
Informant - Address
 
Place of death
 
Facility name (if not a facility, give number and street)
 
City, town, or location of death
 
State of death
 
Zip code of death
 
Method of disposition
 
Place of disposition (name of cemetery, crematory, other place)
 
Disposition - City/town, and state
 
Name and complete address of funeral facility
 
Date of disposition
Added
Funeral director signature
 
Causes of death and intervals between onset and death
 
Other significant conditions contributing to death
 
Autopsy?
 
Were autopsy findings available to complete the cause of death?
 
Manner of death
 
Pregnancy status
 
Did tobacco use contribute to death?
 
Date of injury
 
Hour of injury
 
Place of injury
 
Injury at work?
 
Injury location - Street, city, county, state, zip
County Added
Describe how injury occurred
 
Transport injury type
 
Certifying physician signature
 
Medical examiner/coroner signature
 
Name and address of certifier
 
Hour of death
 
Name and title of attending physician if other than certifier
Added
Date certified
 
Title of certifier
 
License number of certifier
 
ME/coroner file number
Added
Was case referred to medical examiner?
 
County registrar signature
Added
County date received
Added
Record amendment
Added
REPORT OF MARRIAGE
Table 6:
Certification of Marriage
Item Name
Difference from U.S. Standard, if any
Certificate name
Modified
County of license
Added
Date valid
 
Not valid after (date)
 
County auditor signature
 
Date received (by county auditor)
 
Person A - Bride/groom/spouse
Added
Legal name before marriage
Modified
Birth name, if different
Added
Sex
Added
Current residence (street, city/town)
 
County of residence
 
State of residence
 
Date of birth
 
Birth state (if not USA, provide country)
 
Mother/Parent's birth name
Modified
Father/Parent's birth name
Modified
Mother/Parent's birth state (or country)
Modified
Father/Parent's birth state (or country)
Modified
Person B - Bride/groom/spouse
Added
Legal name before marriage
 
Birth name, if different
Modified
Sex
Added
Current residence (street, city/town)
 
County of residence
 
State of residence
 
Date of birth
 
Birth state (if not USA, provide country)
 
Mother/Parent's birth name
Modified
Father/Parent's birth name
Modified
Mother/Parent's birth state (or country)
Modified
Father/Parent's birth state (or country)
Modified
Date of marriage
 
County of ceremony
 
Type of ceremony
Added
Date signed (by officiant)
Added
Officiant's address
 
Officiant's daytime phone
Added
Officiant's name
 
Officiant's signature
 
Witness signature
 
Witness signature
 
Person A signature
Modified
Date signed (by person A)
Added
Person B signature
Modified
Date signed (by person B)
Added
Person A - Social Security number
Added
Person A - Name
Added
Person B - Social Security number
Added
Person B - Name
Added
Person A signature - Declaration in absence of a Social Security number
Added
Person A date - Declaration in absence of a Social Security number
Added
Person B signature - Declaration in absence of a Social Security number
Added
Person B date - Declaration in absence of a Social Security number
Added
REPORT OF DIVORCE, DISSOLUTION OF MARRIAGE, OR ANNULMENT
Table 7:
Certification of Dissolution, Declaration of Invalidity of Marriage, or Legal Separation
Item Name
Difference from U.S. Standard, if any
Certificate name
Modified
Court file number
Added
Type of decree
 
Date of decree
 
County where decree filed
 
Signature of superior court clerk
 
Spouse A - Name
Added
Birth name, if different
Added
Date of birth
 
Place of birth (state or country)
 
Residence - Street
Added
Residence - City
 
Residence - County
 
Residence - State
 
Spouse B - Name
Added
Birth name, if different
Modify
Date of birth
 
Place of birth (state or country)
 
Residence - Street
Added
Residence - City
 
Residence - County
 
Residence - State
 
Place of marriage -County
 
Place of marriage - State
 
Date of marriage
 
Number of children born alive of this marriage
Added
Petitioner
 
Name of petitioner's attorney or pro se
 
Petitioner's attorney's address
 
Spouse A Social Security number
Added
Spouse B Social Security number
Added
Table 8:
Certification of Dissolution of Washington State Domestic Partnership
Item Name
Certificate name
Court file number
Type of decree
Date of decree
County where decree filed
Signature of superior court clerk
First partner's name
First partner's name at birth
First partner's date of birth
First partner's place of birth
First partner's residence - Street
First partner's residence - City
First partner's residence - Inside city limits
First partner's residence - County
First partner's residence - State
Second partner's name
Second partner's name at birth
Second partner's date of birth
Second partner's place of birth
Second partner's residence - Street
Second partner's residence - City
Second partner's residence - Inside city limits
Second partner's residence - County
Second partner's residence - State
Date of this partnership
Domestic partnership certificate number
Petitioner
Name of petitioner's attorney/pro se
Petitioner's address
[Statutory Authority: 2019 c 148. WSR 20-13-017, § 246-491-149, filed 6/5/20, effective 1/1/21. Statutory Authority: RCW 43.70.150 and 26.60.100. WSR 14-04-092, § 246-491-149, filed 2/4/14, effective 3/7/14. Statutory Authority: RCW 43.70.150. WSR 13-01-004, § 246-491-149, filed 12/6/12, effective 12/6/12. Statutory Authority: RCW 26.09.150. WSR 09-11-111, § 246-491-149, filed 5/19/09, effective 6/19/09. Statutory Authority: RCW 43.70.150, 70.58.055, and chapter 70.58 RCW. WSR 02-20-092, § 246-491-149, filed 10/1/02, effective 11/1/02. Statutory Authority: RCW 43.70.150. WSR 91-23-026 (Order 211), § 246-491-149, filed 11/12/91, effective 12/13/91. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-491-149, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.20A.620. WSR 88-19-034 (Order 2696), § 248-124-160, filed 9/12/88.]
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