Client required information form..

Loved One's Legal Name

First NameMiddle NameLast NameSuffix

Date of Birth

Date

Date of Passing

Date

Place of Passing (Hospital, Medical Examiner, Hospice facility, Residence, Nursing home, other)

Name of place of Passing:

Address of place of Passing

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Telephone number of place of Passing

Please enter a valid phone number.Format: (000) 000-0000.

Time of Passing if Known

Hour & Minutes Minutes

AM/PM Option

Age at Time of Passing

Birthplace (City/State if Born in the US)

Social Security Number

We notify Social Security of your loved one's passing.

Marital Status at Time of Passing

Maiden Name of Spouse if Applicable

Legal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Former Occupation

We cannot place retired.

Former Industry/Business

Highest Level of Education

Race

Please Specify Race

Hispanic or Haitian Origin

Please Specify Haitian or Which Hispanic Ethnicity

Were they ever in the Armed Forces?

Please Specify Which Branch

Mother's Name with Maiden Name

Father's Name

Legal Next of Kin's Legal Name

First NameLast Name

Legal Next of Kin's Relationship to Deceased

Legal Next of Kin's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Legal Next of Kin's Email

example@example.com

If your loved one has a pacemaker or defibrillator, do we have the authority to remove the device before cremation and return it to the manufacturer?

Do we have authority to remove the items before cremation and return to manufacturer?

Are there any valuables that you are expecting back?

Do we have your authority to cremated any clothing items found with your loved one?

Do we have your authority to take a copy of your loved one's right thumb print?

Which urn out of the attached 2024 Simple Cremation package urn options would you like your loved one's ashes placed in?

Would you like to view your loved one again?

Would you like to pick up your loved one's ashes or have them mailed to you?

Name of the Person Allocated to Collect Loved One's Ashes

First NameLast Name

Phone Number of the Person Allocated to Collect Loved One's Ashes

Please enter a valid phone number.Format: (000) 000-0000.

Which of our convenient cemetery locations would you prefer to visit to pick up your loved ones ashes?
Our local pick-up locations are listed below. If you don’t see one near you, we can help connect you with a nearby affiliate – call us directly on 941.312.6371 or 888.768.6035.

Type a question

Name of the Person We are to Mail Loved One's Ashes

First NameLast Name

Address of the Person We are to Mail Loved One's Ashes

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number of the Person We are to Mail Loved One's Ashes

Please enter a valid phone number.Format: (000) 000-0000.

If loved ones’ ashes are to be mailed, a $250 fee applies (GPL Link) , and they will be sent via USPS Priority Express Mail. Once shipped, we will provide tracking information so you can follow their progress home. If your loved one is in the Basic package, the temporary urn is not suitable for mailing. A mailing urn is available for $95 (Urn GPL link) and will be needed for mailing.

A funeral director will reach out to the legal next of kin to clarify information and forward necessary documents to proceed with arrangements.

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Required Information Form