The director shall establish a certificate of stillbirth for a fetal death, as defined in RSA 5-C:1, XII, occurring in this state on the following form:
New Hampshire Certificate of Stillbirth
Name of Parents: _________________________ Date of Stillbirth: _________________________ Place of Stillbirth: _________________________ Name parents choose: _________________________ (optional) Issued by New Hampshire division of vital records administration
________________________ __________
Director of vital records Date