Weber County Attorney

Full Name of Deceased:

Date of Birth:

Date of Death:

Suspected Manner of Death:

Agency Case Number:

Address of Occurrence:

Homeless:

Next of kin Notified:

Initial Officer/Assigned Detective:

Injury at Work:

Injury Witnessed:

Funeral Home:

Pre-Existing Health Conditions:

Investigative Summary:

Email of individual submitting this form:

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By submitting, you affirm and declare the above information is true and correct.