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CERTIFICATE OF DEATH

rho
box lh9t best describes whether the decedent is
tho "No" box if
de<:edenlls nor Spanish/Hispanic/Lallno)
Spanis~JHispanic/Ls~no. C~ock

I&]

No. nor Spanlsh/Hispanlcllalino

Yes. Mexican. Mexican American. Chicano

STATEF'ILENUMBEA

2015 04967 4

one or more
or herself to be)
Vietnamese
I&] Olher Asian (Spocoly)

Kuwaiti

Native HawaiiC'In

Yes , Puerto Rican

Yes, Cuban

Osamoan

0
D
0

Yes . other Spanish/Hispanlcllallno (Specify)

Un~nown

Guamanian or Charnorro

O Other Padfic Islander (Specify)

0 or~er (Specify)