Contact PersonName* First Middle Last Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Email Phone*Cell PhoneWork PhoneRelationship to Deceased* Deceased Person InformationName* First Middle Last Sex*MaleFemaleDate of Death* MM slash DD slash YYYY Place of DeathFacility Name(If applicable) Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Date of Birth* MM slash DD slash YYYY Birthplace: City, State, Country* Deceased's Residence* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Marital Status*MarriedNever MarriedWidowedDivorcedName of Spouse (maiden name, if wife) In Armed Forces*YesNoBranch 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)*123456789101112Higher Education*NoneSome College CreditAssociates DegreeBachelors DegreeMasters DegreeDoctorateFatherFather'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 MotherMother'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 InformationCemetery Name Location City/Location State of Cemetery Religion InformationChurch Name Denomination Church Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Church PhoneClergy Name First Last Clergy PhoneFamily InformationChildren (oldest to youngest with spouse info)First (Spouse) LastGrandchildren (oldest to youngest with spouse info)First (Spouse) LastGreat Grandchildren (oldest to youngest with spouse info)First (Spouse) LastSiblings (oldest to youngest with spouse info)If siblings are deceased, please type "deceased" before the respected name.First (Spouse) LastMembership in Organizations, Clubs or SocietiesOrganizations, Clubs, Societies: Name & Contact InformationUse separate line for each entry. People / Groups to Notify about Funeral ServicesName of Person / Group & Email AddressUse separate line for each entry. Δ