vitals

Please fill in the form here so that we can quickly and completely address your needs.
We are here to help so please answer as much information as you can using the form on this page.

Decedent’s Legal Name:

Date of Death:

Usual Residence State:

County:

Town:

Street and Number:

Apt No.:

Zip Code:

Date of Birth:

Social Security No:

Age at last birthday:

Usual Occupation:

Kind of industry:

Aliases or AKA:

Birthplace:

Education:

Ever in US Armed Forces? YesNo

Marital/Partnership Status at time of death:

Surviving Spouse/Partner’s Maiden Name:

Father’s Name:

Mother’s Maiden Name:

Informant’s Name(required):

Relationship to Decedent:

Phone(required):

Address:

Name of Cemetery/Crematory:

Location of Cemetery/Crematory:

Date of Disposition:

Your Email(required):

Are the remains being shipped - if shipping please include name of destination (Country or State if in the US below) :

Name of Airport:

Name of Funeral home or Person Receiving Remains:

Address:

City, State & Country:

Telephone number:

Your Message/Other Information: