Form DLD421 template
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Deceased Record Form
This document is a deceased record form for submitting information regarding a deceased individual to the Driver License Division of Utah. Required fields include name, date of birth, license number, date of death, employee number, and signature of the person completing the form. The source of the information and date of record update are also required. Written verification such as a death certificate, funeral program, or obituary must be attached and submitted to dlarchives@utah.gov or Driver License Division in Salt Lake City, UT.
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