Decedent's full legal name: First:required *
Middle:
Last:required *
Last name prior to first marriage: (if applicable) ?
Sex:required *(according to official records) Select sex: Male Female
Age at last birthday:required *
County and state of birth:
County:
State: Please select: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington, D.C. Other/Foreign Country (please specify)
If other or foreign country, please specify:
Date of birth:required *
Date of death:required *
Location of death:(for NC record keeping) ?required * Please select: Decedent's home Hospice facility Nursing home/long-term care facility Hospital (inpatient) Hospital (ER/outpatient) Hospital (dead on arrival) Other (please specify)
If other, please specify:
City or town:required *
County of death:required *
Marital Statusrequired * Please select: Married Separated Divorced Never married Widowed Unknown
Surviving spouse's name (if wife, use maiden name):
Decedent's usual occupation (do not use retired or disabled):If retired or disabled, please list last occupation before retirement or disability. ?required *
Kind of business/industry:required *
Social Security Numberrequired *
Decedent's residence:
Residence State: Please select: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington, D.C. Other/Foreign Country (please specify)
If foreign country, please specify:
County:required *
Street and number:required *
City:required *
Zip Code:required *
Is the residence within city limits?required * Please select: Yes No
Background:
Was the decedent ever in the U.S. Armed Forces?required * Please select: Yes No
If yes, is a copy of the decedent's military discharge papers available? If applicable, please select: Yes No
Education completed:(the highest degree or level of school completed at time of death) ? Please select: 8th grade or less 9th-12th grade; no diploma High school graduate or GED completed Some college credit, but no degree Associate degree Bachelor's degree Master's degree Doctorate or Professional degree
Decedent's Race:(if multiple, please specify below) ? Please select: Black or African American White Hispanic Other (please specify)
Please specify if necessary:
Decedent's father's full legal name: First:required *
Middle:
Last:required *
Informant:
Name of person making arrangements (the "informant"):required *
Informant's relationship to decedent:required *
Informant's address:
Street and number:required *
City:required *
State: Please select: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington, D.C.
Zip Code:required *
Informant's telephone number:required *
Informant's email address:required *
Was the decedent under hospice care at the time of death?required * Please select: Yes No
Name of hospice provider:(if yes) ?
Did the decedent have a pacemaker?required * Please select: Yes No
Three (3) Certified Death Certificates are already included. Please note any additional certificates needed here.
Death certificates requested:(each additional certificate after the first three costs $15) ?required *
3 certificates included + = 3 total death certificates.
IMPORTANT: Please do not rely on nursing staff, social workers, first responders and/or transportation staff to relay important information or messages regarding your loved one. For example, questions, comments or concerns regarding your loved one’s personal effects (jewelry, clothing, etc) that you wish to be removed and returned, should be communicated directly to a City of Oaks Cremation, LLC Funeral Director.
Yes, please publish a shareable online obituary for free.(we'll host it on our site and you'll have time to provide a brief obituary and a photo later) ?
We are committed to making this process as easy as possible for you. Please do not hesitate to call us with any questions and/or concerns. We are available to you 24 hours a day / 7 days a week.
