Online Planner

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Your Contact Information

First Name

Middle Name

Last Name

Your Email Address

Your Phone Number

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Select Your Optional Services

Please select from the following optional service offerings to complete your arrangement plans:

Private family viewing $300.00

Assistance with filing life insurance claims/assignments $300.00

Courier service (Delivery of death certificates and cremated remains to you are outside of the city limits) $100.00

Certified death certificates (if using courier service) $50.00

Additional certified death certificates (if using courier service) $10.00 for each copy

Additional cremation fee is deceased weighs more then 350 lbs $695.00

Copy of thumbprint for jewelry (No charge if jewelry is purchased through our third party vendor) $100.00

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Deceased Information

This information is used to complete the death certificate and cremation permit, and to notify Social Security. All provided information must be accurate.

Mother's Name

Mother's Address

Last Name

Street Address

City

State

Zip

Place of Death

Date of Death

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Deceased's Vital Information

Sex

Marital Status

Date of Birth

City of Birth

State of Birth

Social Security Number

Race

Occupation

Education

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Deceased's Spouse/Parental Information

Spouse First Name

Spouse Last Name

Spouse Deceased Date (if deceased)

Father First Name

Father Last Name

Father Deceased Date (if deceased)

Mother First Name

Mother Last Name

Mother Deceased (if deceased)

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Deceased's Next-of Kin Information

The legal next-of-kin is required to sign.

Note: only the person or persons in each category listed below is required to sign. To determine next-of-kin, the categories below must be followed in descending order. Categories cannot be skipped if there are living members in the category, unless they are incapacitated or their whereabouts are unknown. In either case, documentation will be required attesting to their circumstances. Contact our office for help regarding this situation.

The descending order of legal next-of-kin is as follows...

Spouse of deceased
All children over the age of 18
Custodial parent
Non-custodial parent

Next-of-Kin Name

Relationship to Deceased

Phone Number

Street Address

City

State

Zip

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Online Planner Form Responses

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