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Coroners - Request for Assistance Submission Form

Please complete the following information when requesting assistance in locating the next of kin for a decedent. While we understand that the available information may be patchy or iffy and that certain details cannot be publicly disclosed, sharing as much information as permissible in your initial contact with Unclaimed Persons will greatly improve the research process and minimize delays. Initial submissions are private and we honor all requests to remove specifics provided before posting a case.

* Indicates Required Information

Submitting Agency Information:
* Name of Agency:
Website: (do not use http:// in URL)
* Email Address:
Contact Person:
Decedent Information:
Decedent Name:
Nicknames or Aliases, if any:
Date of Death:
Death Location (City, County and State):
Date of Birth:
Estimated Age at Death
(if no DOB is available):

Birth Location (City, County and State):
Social Security Number:
Mother's name(including mother's
maiden name, if known):

Father's name:
Yes:        No:
Last Known Address:
Identifying Marks (tattoos, etc.):
Employer Information, if any:
How identification was made:
Please share any other family or other details that might be helpful:
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