If you do not want to submit the deceased information online, You can print the form below, fill it out with a pen, and take it to your local funeral director. The Print option is below the form.

Name of the person who died___________________________________________________________

· Date and location of death _____________________________________________________________

· Age at death __________

· Date and location of birth: BIRTH MOTHER NAME _________________________________________

BIRTH FATHER NAME________________________________________________________________

IF ADOPTED, NAME OF ADOPTERS____________________________________________________

· Education, (LIST ALL SCHOOLS ATTENDED, AND WHERE THOSE SCHOOLS WERE LOCATED, WHICH YEARS ATTENDED, ACHIEVEMENTS IN SCHOOL, FAVORITE TEACHERS, ETC)_______________________________________________________________________________

· Marriage information (NAME OF PERSON(S) MARRIED, WHERE THEY WERE FROM, CIRCUMSTANCES OF THEIR MEETING, IF MULTIPLE, LIST ALL)________________________________________________________________________________________________________________

· Names of surviving family members (FOR EXAMPLE: LIST FATHER, MOTHER, CHILDREN, BROTHERS, SISTERS, GRANDCHILDREN, GREAT GRANDCHILDREN, AUNTS, UNCLES, COUSINS, NIECES, NEPHEWS, GRANDPARENTS, NOT ONLY IDENTIFYING THEM BUT LISTING THEIR TOWNS OF RESIDENCE) IF ANY OF THEM ARE PARTICULARLY ACCOMPLISHED, SO STATE__________________________________________________________________________________________________________________________________________________________

Names of relatives who predeceased the deceased( FOR EXAMPLE: FATHER, MOTHER, CHILDREN, BROTHERS, SISTERS, GRANDCHILDREN, GREAT GRANDCHILDREN, AUNTS, UNCLES, COUSINS, NIECES, NEPHEWS, GRANDPARENTS, NOT ONLY NAMING THEM BUT LISTING THEIR TOWNS OF RESIDENCE) IF ANY OF THEM WERE PARTICULARLY ACCOMPLISHED, SO STATE___________________________________________________________________________________________________________________________________________________________________________________________

· Professional information, professional interests and achievements: (LIST ALL JOBS HE/SHE HELD, WHAT TOWNS THOSE JOBS WERE IN, LEVEL OF MANAGEMENT OR RANK ACHIEVED, AWARDS EARNED, THE ACCOMPLISHMENTS OF WHICH THE DECEASED WAS MOST PROUD, ANY SPECIAL EXPERTISE, ANY NOTABLE ASSOCIATES, PARTNERS, CORPORATIONS ESTABLISHED, ETC)__________________________________________________________________________________________________________________________________________________________________________________

Hobbies/recreational activities. (FAVORITE LAKE, MOUNTAINS HIKED,) etc..__________________________________________________________________________________________________________________________________________________________________________________

Exactly how he/she died: (CAR ACCIDENT, OVERDOSE, HEART ATTACK, ETC. Be very specific. Certain diseases or conditions are hereditary and it may be important for family members and prospective family members to have that information. _________
___________________________________________________________________________________________________________________________________________________________________________________

· Funeral service details, including name of funeral
home_______________________________________________________________________________________________________________________________________________________________________________

· Charity donation information (if any)________________________________________________________________________________________________________________

You can print this form, fill it out, and take it to your local funeral director.