vitals 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: 8th grade or less9th-12th grade; no diplomaHigh School graduate or GEDSome college creditAssociate’s degreeBachelor’s degreeMaster’s degreeDoctorate or Professional degree Ever in US Armed Forces? YesNo Marital/Partnership Status at time of death: MarriedDomestic PartnershipDivorcedMarried, but separatedNever MarriedWidowedUnknown 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) :YesNo Name of Airport: Name of Funeral home or Person Receiving Remains: Address: City, State & Country: Telephone number: Your Message/Other Information: Enter this code to prove you are human: To use CAPTCHA, you need Really Simple CAPTCHA plugin installed. 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.