Contact Person
Name*
First Middle Last
Address*
Street Address City Province Postal Code
Email
Phone*
Cell Phone
Work Phone
Relationship to Deceased*
Deceased Person Information
Name*
First Middle Last
Sex*
Date of Death*
MM slash DD slash YYYY
Place of Death
Facility Name(If applicable)
Address*
Street Address City Province Postal Code
Date of Birth*
MM slash DD slash YYYY
Birthplace: City, State, Country*
Deceased's Residence*
Street Address City Province Postal Code
Marital Status*
Name of Spouse (maiden name, if wife)
In Armed Forces*
Branch of Service*
Years of Service*
SIN

The SIN is required to complete the arrangements. If you don't feel comfortable entering the information here, we will call you by telephone to retrieve the SIN.
Usual Occupation*
Kind of Business/Industry*
Education (highest completed) Elementary & Primary (0-12)*
Higher Education*
Father
Father's Name*
First Middle Last
Legal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.
Step-Father Name
Birthplace: City, Province, Country
Mother
Mother's Name*
First Middle Last
Legal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.
Maiden (last) Name*

Legal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.
Step Mother Name
Birthplace: City, Province, Country
Cemetery Information
Cemetery Name
Location City/Location State of Cemetery
Religion Information
Church Name
Denomination
Church Address
Street Address City State ZIP Code
Church Phone
Clergy Name
First Last
Clergy Phone
Family Information
Children (oldest to youngest with spouse info)
First (Spouse) Last
Grandchildren (oldest to youngest with spouse info)
First (Spouse) Last
Great Grandchildren (oldest to youngest with spouse info)
First (Spouse) Last
Siblings (oldest to youngest with spouse info)
If siblings are deceased, please type "deceased" before the respected name.
First (Spouse) Last
Membership in Organizations, Clubs or Societies
Organizations, Clubs, Societies: Name & Contact Information
Use separate line for each entry.
People / Groups to Notify about Funeral Services
Name of Person / Group & Email Address
Use separate line for each entry.

Contact Person

Deceased Person Information

Place of Death

Father

Mother

Cemetery Information

Religion Information

Family Information

Children (oldest to youngest with spouse info)

Grandchildren (oldest to youngest with spouse info)

Great Grandchildren (oldest to youngest with spouse info)

Siblings (oldest to youngest with spouse info)

Membership in Organizations, Clubs or Societies

People / Groups to Notify about Funeral Services