Client required information form..

Required Information Form
Loved One's Legal Name*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Date
Date of Passing*

MonthDayYear
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.
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*

WhiteBlackAmerican Indian or Native (Please Specify Tribe)Asian IndianChineseFilipinoJapaneseKoreanVietnameseOther Asian (Please Specify)Native HawaiianGuamanian or ChamorroSamoanOther Pacific Islander (Please Specify)Other (Please Specify)
Please Specify Race*
Hispanic or Haitian Origin*

YesNo
Please Specify Haitian or Which Hispanic Ethnicity*
Were they ever in the Armed Forces?*

YesNo
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?*

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

YesNo
Are there any valuables that you are expecting back?*
Do we have your authority to cremated any clothing items found with your loved one?*

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

Yes -- This is a complimentary service. The print can be used for any jewelry or personal items you or your family may want as a keepsake.No
Which urn out of the attached 2024 Simple Cremation package urn options would you like your loved one's ashes placed in?*

OmegaBeacon Water UrnDove VaseMoonlight Blue VaseNatural Cube
Would you like to view your loved one again?*

Yes -- Our private family moment, with no embalming, is 30 minutes for up to 10 immediate family members for $700. Once your loved one is in our care, we will schedule the private moment. Private family moments take place M- F at 10am.No -- Please email us a color copy of the legal next of kin's ID and deceased loved one's ID for identification purposes.
Would you like to pick up your loved one's ashes or have them mailed to you?*

Pick UpMailed -- This is an extra charge of $195. The loved one's ashes will be sent via certified mail with USPS.
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.
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

Robert Toale and Sons Funeral Home at Palms Memorial Park - 170 Honore Ave, Sarasota, FL 34232. 941.371.4962Robert Toale & Sons Funeral Home at Manasota Memorial Park - 53rd Avenue East and, 301 Blvd E, Bradenton, FL 34203. 941.755.2688
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.
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.
Please verify that you are human*
Should be Empty:

Required Information Form