Fetal Death Certificate

* Required field

Fetal Death Record Information

Birth/Legal Parent Information

Birth/Legal Parent 1

Birth/Legal Parent 2

Sworn Statement

By entering my full name in the space provided below I swear or affirm under penalty of perjury under the laws of the State of California, that I am an authorized person, as defined by the California Health and Safety Code Section 103526 (c), and am eligible to receive an authorized copy of this stillbirth certificate.

The County of Riverside is not responsible for the delivery of mail by the United States Post Office or any other delivery service.