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Vital Information Form
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Home
Obituaries
About
Vital Information Form
Planning
Veterans
Resources
Contact Us

Vital Information Form

We are very sorry for your loss and stand ready to assist you in your time of need. If you have not already scheduled an arrangement conference with us, please call us.

Please take the time to complete the survey form below, which may require some outside research. Fill out the form completely and accurately, prior to our arrangement conference. List the information exactly as it appears on the decedent’s: passport, birth certificate and social security card. This is information used to complete legal documentation.

Decedent’s Vital Information Details

Decedent’s Personal Information

Decedent’s Full Name [as listed on their birth certificate (or passport)], Then Address Below.

Street

City

State/Province

ZIP/Postcode

Decedent’s Date of Birth (month/day/year), Decedent’s Age

Decedent’s Place/Country of birth, What Country is the Decedant a Citizen of?

Decedent’s Social Security Number

Next-of-Kin’s (NoK’s) Full Name, Phone Number & Email Address

NoK’s Mailing Address

Decedent’s Father's Name

Decedent’s Father's Place of Birth- City, State, Country

Decedent’s Mother's Name AND What Was Her Maiden Name:

Decedent’s Mother's Place of Birth- City, State, Country

What was the Decedent’s Marital Status:

Decedent’s Spouse's Name

Spouse's Maiden Name

Work/Education History

Decedant’s Highest Education Level Completed

Grade-School

Attended High School, Did Not Receive Diploma

Completed High School (Diploma, or GED)

Attended College, Did Not Earn Degree

Completed Associate’s Degree

Completed Bachelor’s Degree (B.S./B.A.)Completed Masters Degree

Completed Doctorate

Decedent’s Occupation During Life

Company Name

Business Field

Military Record

Did Decedent Serve in the Military?

YesNo

Branch of Service

Date Entered Service

Date Discharged

Serial Number

Rank at Discharge

Do you have a copy of decedent’s discharge papers (DD214)?

Yes, email to director, or bring to arrangementNo

Name of Informant AKA The Person Who Notified Us of the Decedent’s Passing. AND What is the Informant’s Relationship to the Deceased i.e.: Spouse, Child, Grandchild, Parent, Sibling, Niece / Nephew, Friend, Etc.

Informant’s Phone # & Email Address

Informant’s Mailing Address

Funeral Service Request

Place of Service

Name & Address of Church/Place of Service

Phone Number & Contact Person for Church/Place of Service

Religious Denomination

Social/Service Organization Member- Lodge/Union/Fraternity/Sorority/Professional Association Member?

Place & Address Where Decedent Passed Away AND The Place and Address Where Decedent is Located Now:

Disposition Request

Select Which Applies

Name of Cemetery

Cemetery Address, Must Be Able to Accurately Locate, i.e. on Google Maps.(if applicable)

Cemetery Phone Number & Contact Person(if applicable)

Name of Foreign Funeral Home Receiving Body (Write “Philip Rinaldi” for local services)(if applicable)

Foreign Funeral Home Phone Number & Contact Person (List “N/A” for Local Funerals)

Foreign Funeral Home Phone #

Summary Details

Please Provide Decedent’s: Passport, Birth Certificate, or Government-Issued ID AND The Next-of-Kin’s ID, Preferably Scanned/Emailed Prior to Arrangement. Are There Additional Instructions That You Have for Us, i.e. Caring for, or the Appearance of the Body, Etc.?

Please select:

I Have Accurately and Thoroughly Completed the Form Above, Please Contact Me for an Appointment to Finalize Arrangements

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