At-Need Form

Personal Information of Deceased

Last Name

First Name

Middle Name

Date of Birth

Social Security Number

Date of Death

Time of Death

Preparation Information

Has a Doctor / Coroner Been Notified?

YesNo

If deceased passed at home

Has the Body Been Released for Removal?

YesNo

Do You Permit Us to Cremate the Body?

YesNo

If Yes, Who Has Granted Permission?

Physician Information

Name of Doctor Signing Death Certificate

Street

City

State/Province

ZIP/Postcode

Business Telephone

Email Address

Person Legally Responsible for Disposition

Last Name

First Name

Middle Name

Relationship to Deceased

Street

City

State/Province

ZIP/Postcode

Primary Phone Number

Best Time to ReachVia phone

Secondary Phone Number

Do You Have a Prearrangement on File with Us?

YesNo

If Yes, Under What Name?

Photograph For Online ObituaryNot Required

Select A Cremation Plan

DirectScattering at SeaVoyager LaunchFinal Journey

Not Required

Call Us Today at(720) 295-9565