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Fillable Printable Form DS-2060

Fillable Printable Form DS-2060

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 fullAge
(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
DayHourMinuteYear
Place of death
Number and street, or Hospital/ hotelCityCountry
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:
NAMEADDRESS
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: SSAVA
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.
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