step 4: PAPERWORK
Vital Statistics
Vital Statistics for Death Certificate
*First Name:
*Last Name:
*Middle Name:
*Sex:
*Race:
*Date of Birth:
*Place of Birth:
City:
State:
Country:
State:
Country:
*Date of Death:
*City of Death:
*State of Death:
*County of Death:
*Location of Death:
If other, please indicate address:
*Name of the Place of Death:
*Education
*Usual Occupation (most of life):
*Kind of Business:
*Company:
*Marital Status:
Full Name of Surviving Spouse:
If Wife, Provide Maiden Name:
*Residence - Street Address:
*City/Town:
*Inside City Limits:
*County:
*State:
*Zip Code:
*Length of Residence In County:
*Father's Full Name:
*Mother's Full Maiden Name:
Type of Disposition
Disposition Will Be:
Cremation
Preparation and Viewing
Important Note: Viewing of the body is a choice of the family. In most cases, embalming is required or recommended for public viewing/visitation, mausoleum entombment, or transfer of remains via common carrier (i.e. shipment by air or rail). When possible, the funeral home needs authorization from the next of kin for embalming.
Except in certain cases, embalming is not required by law. Embalming may be necessary, however, if you select certain funeral arrangements, such as a funeral with viewing. If you do not want embalming, you usually have the right to choose an arrangement, which does not require you to pay for it, such as a direct cremation, immediate burial and/or one-time ID viewing for family only. If you elect NOT to order embalming, State law requires refrigeration of an unembalmed body that is held for over 24 hours from the time of death.
*The Family Preference Regarding Viewing/Embalming Is:
*I Authorize Tri-State Cremation Society To Embalm
*Name of Authorizing Person
*Relationship To Deceased:
Veteran Information
*Was Decedent Ever In the US Armed Forces?:
(if no, continue to next section)
Branch of Service:
Date Enlisted
Date Discharged
Honorable Discharge:
Military Serial Number:
Is A Copy of Discharge Papers Available?
(if yes, please bring for us to copy)
Informant/Person In Charge Information
*First Name:
*Last Name:
*Relationship To Deceased:
*Email Address:
*Address:
*City:
*State:
*Zip Code:
*Telephone Number:
Funeral/Memorial Service Information
Preferred Place of Service:
Religious Denomination:
*Has the decedent/person being planned for purchased pre-need funeral insurance through Tri-state Cremation Society?
Other Information & Instructions
Please list any other instruction or information you would like us to have:
*Would you like us to publish an obituary on our Website?
($20 fee) :
($20 fee) :