Peeples Family Funeral Home

Peeples Family Funeral Home

Request for Transfer of a Loved One
Your Name*
Your Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name of Decedent. *

First NameLast Name
Date of Death*
Time of Death*
Type of Removal*

FacilityResidenceUnknown
Date of Birth*
Facility Name and Address

Location Name

Street Address

City/TownState / Province

Zip Code
Person Calling
Number for Nurse/Officer/Facility
Please enter a valid phone number.Format: (000) 000-0000.
Next of Kin*
Number for Family*
Please enter a valid phone number.Format: (000) 000-0000.
Relation
Family Email*
example@example.com
What is the decedents approximate weight? *

Under 300lbOver 300lbUnknown
Any additional specifics we should be aware of?
Once submitted, a team member will contact you with a timing of the transfer and to obtain any further information we may need. If you do not receive a call from us within 15 min, please call our office at 904-764-2542.
Should be Empty:

Once submitted, a team member will contact you with a timing of the transfer and to obtain any further information we may need. If you do not receive a call from us within 15 min, please call our office at 904-764-2542.