WAC 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 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 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 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 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 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 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