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Vital Information

To keep this as stress-free as possible, fill out this form or bring this information with you.

Full Legal Name

Home Address

Social Security Number

Date of Birth

Place of Birth

Marital Status

Father’s Name

Mother’s Maiden Name

Veteran’s discharge papers (DD-214)

Military Service Branch- Rank

Date of Enlistment

Date of Discharge

Names of Tours of Duty

Name of Cemetery

Cemetery Location

Highest Education

Occupation

Fraternal Organizations

Service Organizations

Union Memberships

Any Special Recognitions

Hobbies, Interests

Clergy name and phone number

Insurance policy information if using to pay for funeral expenses*

Informant Name

Informant Email Address

Informant Phone Number

Relationship

Secondary Contact

The information requested is required and must be completed for the death certificate.

Please bring a recent photo and any clothing you’d like us to use.