(530) 342-9003


(530) 873-7602

Vital Statistics Form

We feel one of the most caring things anyone can do for their family is to prepare and plan in advance. We understand the need and sensitivity of planning one’s arrangements. Planning eliminates the uncertainty and confusion about one’s wishes.

Please fill in the following spaces below and we will keep all your information on file and send you an I.D. card for your wallet. If you would like further help with this matter or more information you can call us at (530) 342-9003.

Please Complete Only Those Options That Apply
NOTE: This information is needed for the death certificate only.
For more information on how this information will be used, please view our privacy policy at the end of the form below.
TIP: Press the TAB key to move to each form field

  • Person Who Filled Out Form

  • Who The Plan is For

  • Person in Charge

  • This field is for validation purposes and should be left unchanged.

Newton Bracewell Funeral Homes are committed to respecting the privacy of our website visitors. Any data which you provide us is not shared with third parties unless required by law. Personally identifiable information will not be sold, rented, or exchanged with any other organization or entity unless you are first notified and expressly agree to it.


This website contains links to other websites. We will not be responsible for the accuracy or reliability of any information, advice, data, opinions, or statements found on these websites.


Any changes to these policies will be posted on this page.