FIRST CALL SHEET REPORT
FUNERAL HOME (OPTIMA LA , OPTIMA PARAMOUNT)
*
NAME OF DECEDENT
First Name, Middle Name, Last Name
AKA
DATE OF BIRTH
/
Month
/
Day
Year
Date
DATE OF DEATH
/
Month
/
Day
Year
Date
TIME OF DEATH
GENDER
SOCIAL SECURITY
APPROX WEIGHT
HEIGHT
REMOVAL FACILITY NAME
APT/ROOM
FACILITY PHONE NUMBER
-
Area Code
Phone Number
FACILITY Address
STREET ADDRESS
Street Address Line 2
CITY
STATE
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 Code
Phone Number
NOK Address
STREET ADDRESS
Street Address Line 2
CITY
STATE
ZIP CODE
DOCTORS NAME
DOCTORS PHONE NUMBER
-
Area Code
Phone Number
DOCTORS FAX NUMBER
DR. Address
STREET ADDRESS
Street Address Line 2
CITY, STATE, ZIP CODE
State / 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
*
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