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Information Forms
Information Form (Immediate Need)
Information Form (Pre-Need)
Services
Cremation Services
Graveside Services
About Us
Contact
SFS Info Form
Decedent's Full Name
(Required)
Decedent's Full Address (Street, City, State & Zip code, include county of residence)
(Required)
Place of Death (name & address of facility, if applicable)
(Required)
Date of Death
(Required)
MM slash DD slash YYYY
Date of Birth
(Required)
MM slash DD slash YYYY
Age
(Required)
Place of Birth (City or Town & State or Country)
(Required)
Social Security Number
(Required)
Ex. 123-45-6789
Veteran
(Required)
Yes
No
Ethnicity/Race (if Hispanic, please give origin e.g. Cuban, Puerto Rican, Dominican, etc.)
(Required)
Gender
(Required)
Marital Status – Check One
(Required)
Never Married
Married
Divorced
Widowed
Separated
Estimated weight in pounds
(Required)
Name of Spouse (for wife, include maiden (birth) name prior to marriage)
(Required)
Father's first and last name
(Required)
Mother's birth name (please do not enter married name)
(Required)
Education Level (list grade completed, HS Diploma or College degree, BA, MA, PhD, etc. if applicable)
(Required)
Usual Occupation During Lifetime (Please Do NOT list Retired)
(Required)
Type of Industry or Business of Occupation
(Required)
Burial or Cremation (if burial, please provide name of Cemetery & plot location)
(Required)
Number of death certificates requested ($10 each NYS & $15 each NYC)
(Required)
Name of Informant & relationship (person authorizing burial or cremation)
(Required)
Informants full address (Street, City/Town, State & Zip code)
(Required)
Informants Email
(Required)
Enter Email
Confirm Email
Informant phone number (Include zip code)
(Required)
Documentation Required
(Required)
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, Max. file size: 8 MB.
Please attach a recent photo of the deceased and a picture ID of the next of kin (signor).
Signature
By checking this box, you confirm all the information is correct.
The information you have provided and consented to will be used to complete the death certificate and to facilitate the necessary documents required for burial or cremation. This information is for this sole purpose only and absolutely no personal information is given out or utilized in any other manner.
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