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At Need Information Form for the Deceased.
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We Accept:

The Information Form Below Must Be Filled Out for the Deceased Person.

(At Need Information and Help Form )

PLEASE USE THIS FORM BELOW: to provide us with as much detail as you can. Please provide all phone numbers of person to contact before you meet with our staff.

*** CREMATION INFORMATION: ***

Anyone requesting cremation please note that the Surviving Spouse must sign the Authorization to Cremate Form.

If the spouse is deceased then all surviving Children must sign the Authorization to Cremate Form.

If it is a child then both parents must sign the Authorization to Cremate Form.

If no family members then the Legal Representative or Representatives must sign the Authorization to Cremate Form. Proof of Representation must be give at time of authorization.

For more information on who must sign Authorization to Cremate please call our office at :

301-253-2138

****(The Family must obtain a Clergy for any services they request.) *****

***** ( PLEASE SEE REMINDER BELOW )!!! *****

NOTE; *** Please do not make or plan any funeral arrangements for any services until you have talked to your funeral director. We will help you plan the Dates and Times for your Services when you meet with us. *********.

( All Funeral and Cremation Services Must Be Paid In Full At Time Of Service. )

PLEASE USE FORM BELOW

PLEASE READ AND FILL IN ALL THE INFORMATION BOXES BELOW.

V V V

*** Please Note: Full Payment Will Be Due At Time of Service For All Our Services. ***

At Need Information Form for the Deceased. START HERE

Personal Information

* Full Legal Name and Address of Deceased * * Full Name and Address of deceased *

Street

City

State/Province

ZIP/Postcode

Telephone Numbers Of Contact Person**

The Deceased Social Number must on this form. SS number must be on this form.

Contact Persons E-mail Address

Deceased Place of Birth City, Town, State,

*** Race of Deceased ***

Place of Death of The Deceased .

( The Deceased) Father's Legal Name Age of Deceased

(The Deceased) Mother's Legal Name

What Was The Mother's Maiden Name ?

What Is The Deceased Persons Marital Status ?

Date of Birth of Deceased.dggfggrggdg

Date of Death of person that has died.

What is the weight of the Deceased?

N/A

Spouse's Legal Name must be on this form!

How many Death Certificates will you need ?

Spouse's Maiden Name

The Death Certificates CAN NOT Be Mailed !

Name and address of The Person That Will Be Making Arrangements Place Your Name and Phone Number And Address in Box AboveAbove

Work/Education History

*** Education / and What Level ? You Must Check One

Grade SchoolHigh-SchoolBachelor's DegreeMasters-DegreeDoctorate

Occupation of The Deceased Now, And Before Retirement

Company Name

Business Field

Military Record

Did you serve in the military?

YesNo

Branch of Service

Date Entered Service

Date Discharged

Serial Number

Rank at Discharge

*****

Do you have a copy of your discharge papers?

YesNo

PLEASE NOTE: To get a flag you must have a copy of the DD214 or Discharge

Name and Address of Personal Representative other than a Family Member

Address

Telephone

Funeral Service Request

** Place of Service **

Name and Telephone Number of Clergy you are using. The Family must obtain a Clergy

** Place of Visitation/ Services other than the Funeral Home **

Religious Denomination

Place of Worship

Lodge/Union/Assoc. Membership

We Require: Payment in Full for Our Services At Time Of Your Arrangements!We Accept: Checks, VISA, MASTERCARD, & DISCOVER CARD. , No Insurance Assignments,

Disposition Request

I Prefer

Name of Cemetery if Earth Burial

Lot # if Known(if applicable)

Section/Letter if known(if applicable)

Grave # if Known(if applicable)

Address of Cemetery if Known

Telephone if Known

I have made a last will and testament

YesNoDo Not Know

Name of County Deceased Lives In ? / Is This in City Limits?

Summary Details

Additional instructions for us:

Did The Deceased Person Have Children, List The Names BelowPlease use the area above to enter the names of children

** Please Read all options from the list below and agree.**

I Understand the Funeral Home will contact me to set up an appointment to make arrangements.

You Must Be On Time For Your Appointment Or You May Be Charged For Our Time.

I Understand that we must obtain our own Clergy for any services.

Please do not make or plan any funeral arrangements for any services until you have talked to your funeral director.

You Must Answer the Security Question below and click Submit in the Green Box

I understand all the options above.

All Removals can take up to 3-4 Hours to remove the body. NO ETA's will be given to anyone.

The Information on this form is true to best of my knowledge.

Anti-Spam Security Question

Thank you, Please click the GREEN submit button when done with the Security Question Above ! >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

DO NOT USE THE FORM BELOW THIS LINE

V V V V V

STOP! STOP! STOP!

DO NOT USE FORM BELOW

STOP HERE !!!!!!!!

At Need Details

Personal Information Form

** Full Name and Address of Deceased

Street

City

State/Province

ZIP/Postcode

Telephone Number of Contact

** Date of Birth **

** Social Security # We must have this! **

** Place of Birth and Race:Race:

Father's Name

Mother's Name

Mother's Maiden Name

Marital Status

Spouse's Name

Spouse's Maiden Name

Additional Family MembersPlease use the area above to enter the names of siblings, children and grandchildren.

Work/Education History

Education Level

Grade SchoolHigh SchoolDegreeMasters DegreeDoctorate

Occupation

Company Name

Business Field

Military Record

Did you serve in the military? If YES We will need a copy of the Discharge or DD214

YesNo

Branch of Service

Date Entered Service

Date Discharged

Serial Number

Rank at Discharge

****

Do you have a copy of your discharge papers?

YesNoThe Funeral Home can not get a Flag without a copy of the Discharge

** Person in Charge of making Arrangements **

** Person in Charge Address **

** Person in Charge Contact Telephone Numbers, **

Funeral Service Request

Place of Service

Place of Service: The Funeral Director will help you with this.

Place and Time of Visitation : The Funeral Director will help you with this.

Religious Denomination

Place of Worship

Lodge/Union/Assoc. Membership

How will you be paying for the Services?

I PreferFor Cremation All Parties must Sign Authorization to Cremate.

Cemetery

Lot #(if applicable)

Section/Letter(if applicable)

Grave #(if applicable)

Cemetery Address if you have it.

Cemetery Telephone

I have made a last will and testament

YesNo

Summary Details

Additional instructions for us

Memorial requests or donations to charity

The Funeral Home will contact you with a time for you to come in and make Arrangements. Please answer the Security Question below and click Submit

Anti-Spam Security Question

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