WAC 246-491-149:

246-491-039 << 246-491-149 >> 246-491-159

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.]