Form Dh 1959 - Affidavit To Release Cause Of Death Information Page 2

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Instructions for Completing
Affidavit to Release Cause of Death Information
(1), (2), (6), (7) This is the person who is legally entitled to receive the death certification with cause of death
information.
(3), (4) This is the decedent who’s name is on the death certificate (the registrant).
(5) This is the person who is to receive the death certification with cause of death information. In order to receive the
certification, this person must provide valid photo identification.
DH 1959, 08/2010, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions)

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