Vital Statistical Information

Let Us Help With Paperwork

As I'm sure you can imagine, when a death occurs in our State, the laws mandate that several documents need to be completed. City of Oaks Cremation, LLC will complete those documents, obtain the Certified Death Certificates, notify the County and the Social Security Administration of the death by using the information the families provide.

Please only fill out this form if you've been instructed to do so by a member of our staff. Call with any questions 919-438-1649.

Decedent's full legal name:

First

Middle

Last

Last name prior to first marriage:

Sex

Age at last birthday

County and state of birth:

County:

State

If other or foreign country, please specify:

Date of birth:

Date of death:

Location of death:

If other, please specify:

Address OR Facility Name:

City or town of death:

County of death:

Marital Status:

Surviving spouse's name

Decedent's usual occupation:

Kind of business/industry:

Social Security Number:

Decedent's residence:

Residence state:

If other or foreign country, please specify:

County:

Street and number:

City:

ZIP Code:

Is the residence within city limits?

Background:

Was the decedent ever in the U.S. Armed Forces?

If yes, is a copy of the decedent's military discharge papers available?

Education completed:

Decedent of hispanic origin?

Please specify if necessary:

Decedent's race:

Please specify if necessary:

Decedent's father's full legal name:

First:

Middle:

Last:

Decedent's mother's full legal name:

First:

Middle:

Last:

Informant:

Name of person making arrangements (the "informant"):

Informant's relationship to decedent:

Informant's address:

Street and number:

City:

State:

ZIP Code:

Informant telephone number:

Informant email address:

Was the decedent under hospice care at the time of death?

Name of hospice provider:

Did the decedent have a pacemaker?

Three (3) Certified Death Certificates are already included. Please note any additional certificates needed here.

Additional Death Certificates requested:

Total certificates you'll receive:

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 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.

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.