FIRST CALL SHEET REPORT

FIRST CALL SHEET REPORT
FUNERAL HOME (OPTIMA LA , OPTIMA PARAMOUNT)
NAME OF DECEDENT
First Name, Middle Name, Last Name
AKA
DATE OF BIRTH

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
DATE OF DEATH

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
TIME OF DEATH
GENDER
SOCIAL SECURITY
APPROX WEIGHT
HEIGHT
REMOVAL FACILITY NAME
APT/ROOM
FACILITY PHONE NUMBER

Area CodePhone Number
FACILITY Address

STREET ADDRESS

Street Address Line 2

CITYSTATE

ZIP CODE
CORONER’S CASE
RELEASER IDENTIFICATION NAME
TITLE
** I HEREBY CERTIFY THAT THE BODY RELEASED INTO YOUR CUSTODY IS THAT OF THE DECEDENT NAMED ABOVE
PRINT NAME OF NOK OR RESPONSIBLE PARTY
RELATIONSHIP
NOK PHONE NUMBER

Area CodePhone Number
NOK Address

STREET ADDRESS

Street Address Line 2

CITYSTATE

ZIP CODE
DOCTORS NAME
DOCTORS PHONE NUMBER

Area CodePhone Number
DOCTORS FAX NUMBER
DR. Address

STREET ADDRESS

Street Address Line 2

CITY, STATE, ZIP CODEState / Province

Postal / Zip Code
WAS THERE CASH YES $ NO AND HOW MUCH
WAS THERE DENTURES YES NO
UPPER LOWER
GLASSES YES NO
JEWLERY
RING
BRACELET
NECKLACE
CLOTHING DESCRIPTION
NOTHING, HOSPITAL GOWN
REMOVAL COMPANY
DRIVERS
PICK UP DATE
PICK UP TIME
DROP OFF TIME
Should be Empty:

** I HEREBY CERTIFY THAT THE BODY RELEASED INTO YOUR CUSTODY IS THAT OF THE DECEDENT NAMED ABOVE