Fillable Printable Form DS-2060

Form DS-2060

REPORT OF DEATH OF A U.S. CITIZEN OR U.S. NON-CITIZEN NATIONAL ABROAD

DS-2060 (Formerly OF-180)

03-2014

Date of Issue (mm-dd-yyyy)

SSA No.

Name in full Age

(Last name)

Date (mm-dd-yyyy) and Place of Birth

Evidence of U.S. Citizenship

Address in U.S.A.

Permanent or Temporary Address Abroad

Date of death

Month

Day Hour Minute Year

Place of death

Number and street, or Hospital/ hotel City Country

Cause of death

Including authority for statement - if physician, include full name and official title, if any

Disposition of the remains

Local law governing disinterment of remains provides that

Disposition of the effects

Person or official responsible for custody of effects and accounting therefore

Traveling/residing abroad with relatives or friends as follows:

NAME ADDRESS

Informed by telegram or telephone

NAME

ADDRESS

DATE (mm-dd-yyyy)

NOTIFIED

Copy of this report sent to:

NAME

ADDRESS

DATE (mm-dd-yyyy)

SENT

Notification or copy sent to Federal Agencies: SSA VA

OPM

Other

State Agency

The original copy of this document and information concerning the effects are being placed in the permanent files of the

U.S. Department of State, Passport Vital Records Section, CA/PPT/S/TO/RS/DO/MR, 1150 Passport Services PL, 6th

Floor, Dulles, VA 20189-1150.

Remarks:

(Continue on reverse if necessary.)

[SEAL]

For Additional Certified Copies, see

(First name) (Middle name) (Date (mm-dd-yyyy) of death)

U.S. Department of State

Post

Signature on all copies

of the United States of America.