A death certificate record includes the deceased's full name and gender; and the cause, time, date, and location of death. Death Statement ; File Name: 502708Deathstatementcurrent.A valid governmentissued ID. The death certificate of the account holder. The account owner's social security number. Download and fill out an order form below. If you are unable to download the form, please call (408) 299-5688 and we will mail or fax you a form. How do I apply for financial aid and what forms should I submit?