Decedent Initial Information

Funerals Your Way would like to extend our sincere sympathies on losing your loved one. At this challenging time, we do our best to have the arrangement process flow smoothly for the family. With this in mind, you may complete the following form before meeting with us. It contains much of the information we will require for the death certificate and will allow us to have most of the paperwork completed and ready for our signature upon your arrival.

If you desire, we can also fax or email the required documents to you for your signature.

If you have any questions, please do not hesitate to contact us.

Decedent Personal Information
First Name
Middle Name
Last Name
AKA. Also Known as
Date of Birth
MM slash DD slash YYYY
Age (years)
Sex
Birth State/Foreign Country
Social Security Number
Date of Death
MM slash DD slash YYYY
Hour of Death (24 hours)
Education (highest level)
Usual Occupation
Kind of Business or Industry
Years in Occupation
Decedant's Race
Decedent Usual Residence
Decedent's Residence
Street Address Address Line 2 City State ZIP Code
Years in County
If in county for less than 1 year - specify 0
Was there military service?
Military Service Information
Branch of Service
Have discharge papers (DD214)?
Marital Status?
Marriage Information
Spouse Name
Spouse Maiden Name
Informant - Person Completing this Form
First Name
Last Name
Relationship
Informant Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Parents
Name of Father - first
Middle
Last
Birth State of Father
Name of Mother - first
Middle
Last (maiden)
Birth State of Mother
Any additional Information
Please specify any addition information that your wish regarding funeral services or your wishes.
Disposition Choice
Number of death Certificates Neeeded ($24 each)
Please enter a number from 0 to 20.
Type of Services Interested in
(ctrl+) for multiple selections
Name
This field is for validation purposes and should be left unchanged.

Decedent Initial Information

Decedent Personal Information

Decedent Usual Residence

Military Service Information

Marriage Information

Informant - Person Completing this Form

Parents

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