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Notification of Hospice Death

  1. Shelby County Coroner Logo
  2. Shelby County Coroner
    108 West College St
    Butch Ellis Bldg Room 107
    Columbiana, Alabama 35051
    Office: (205) 669-3846
    Fax: (205) 669-3886
    (Mailing Address)
    PO Box 1321
    Columbiana, Alabama 35051
    For office use only.
    Case #:
    Date/Time received:
    Employee's name: EVANS
  3. Sex*
  4. Pursuant to Code of Alabama 45-37-60 and 22-9A-14, the coroner’s office should immediately be notified if there is suspicion of criminal violence or criminal neglect, when death occurs in suspicious or unusual circumstances, when deaths are thought to result from trauma or violence, in any prison or penal institution, or when in police custody; whether the cause is known or suspected, primary or contributory, or recent, delayed, or remote.
  5. (e.g. disease, injury/trauma, motor vehicle collision, suspected overdose, etc.)
  6. (Natural, Accident, Homicide, Suicide, Unknown)
  7. Leave This Blank:

  8. This field is not part of the form submission.