Documentation - Just Cremation

Full Cremation Form - No Pre Planning

How may we assist you?*
Please choose a package*
Deceased Information
Please provide us with the following information about the deceased. We will need this information in order to complete the death certificate and move forward with the cremation process.
General Cremation Information
Name*
First Middle Last
Maiden Last Name (if applicable)
Sex*
Date of Birth*
Date of Passing
Age*
Location Information
Location of Your Loved One's Place of Passing (Please enter as much information as you know.)
Address*
Street Address City State ZIP Code
Confirm loved one's address
- The location where my loved one is currently is also their home address
Home Address*
Street Address City State ZIP Code
Place of Birth:*
City State County
Personal Information
Personal Information needed for the Death Certificate
Social Security Number
Name as Listed on Social Security Card (If Known)
First Middle Last
Highest Education Attained*
Race [ex, White, African/American, Asian]*
Ancestry (Countries of Origin)*
Hispanic Origin (Yes or No)*
Military Service (Yes or No)*
What was their job title?*
In what type of business?*
Marital Status*
Spouse's Name at Birth (Only if Married)
First Middle Last
Father's Name*
First Middle Last
Mother's Name at Birth*
First Middle Last
Informant Section
Informant Information
The informant is the person providing us with the information about the deceased.
Informant's Name*
First Middle Last
(This is the person providing the information, whose name and address will also appear on the death certificate.)
Relationship to Loved One*
Informant's Address*
Street Address City State ZIP Code
Informant's Phone*
Informant's Email*
Important Notes
Please provide any important information that would be helpful in your planning. Example: Is your loved one being cared for at home or in hospice? What is the best contact number for the primary caregiver?
Cremation Price Section
Cremation Payment Options
Your total for service is: $950
Your total for service is: $1850
Payment Option
Payment will be taken at the time of passing
Would you like to pay now?*
- I would like to pay online.
- I would like to pay over the phone or in person.

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Call 616.288.9610

616.288.9610

Full Cremation Form - No Pre Planning

Deceased Information

General Cremation Information

Location Information

Personal Information

Informant Section

Informant Information

Cremation Price Section

Cremation Payment Options

Your total for service is: $950

Your total for service is: $1850

Payment Option