OBITUARY / PLANNING FORM

We will need the following information to complete the certificate of death, social security form, and for the obituary notices that will be placed in the newspapers. Please complete the form to the best of your ability and click Submit when you are finished.

Submitter's Information
First
Middle
Last
Fax (If Applicable)
Today's Date
Person Planning For
E-mail
Daytime Telephone Number
Evening Telephone Number

Deceased Information
First Name
Middle Name
Last Name
Sex
Marital Status
Highest Education Level
Street Address
Mailing Address
City
State
County
Zip Code
Length of Stay in County
Is Home Address Inside City Limits
Date of Birth
Place of Birth
Hispanic Origin
Race
Spouse's Full Name
Spouse's Maiden Name
Mother's Name
Mother's Maiden Name
Father's Name

Military Service of Deceased
Branch of Service
Serial Number
Place Enlisted
Date Enlisted
Place Discharged
Date Discharged
VA Claim
or File #

Funerary Information
Type of Service
Place Of Service
Name Of Cemetery
City
State
Grave or Niche Location
Religious Denomination
Church Affiliation
Name of Person(s) to Conduct Service
Name(s)
Viewing For Family
Viewing For Friends
I Prefer
For the family selecting cremation, what dispostion of the remains would you prefer
Musical Selections To Be Played
Musical Selections 
To Be Sung
Life History, Places of Residence, Educational History, Work History, Memberships and Hobbies
Children, Their Spouses, City and State
Number of Grandchildren
Number of Great Grandchildren
Number of Great Great Grandchildren
Siblings, their Spouses, City and State
Other Survivors
Please List Deceased Family Members
Special Instructions or Additional Information
Please note that we will need the Social Security Number as well. Please be prepared to provide the number over the phone or in person.