Immediate Need

If a Death Has Just Occurred

Decedent's Full Legal Name

Legal AKA

Decedent's Address

Birthplace

Date of Birth

Highest Education

Decedent's Race

If Hispanic Origin Please Specify

Father's Full Name

Mother's Full Name (Maiden)

Marital Status

New Field:

Spouse's Name (If Wife, given Maiden name)

Decedent's Occupation / Job Title

Name & Address of Last Employer (if retired please list last employment)

Free Text

Military Service (if applicable)

New Field:

Name of War

Time of Death

Doctor's Name

Free Text

Information/Responsible Party's Information

Name

Address

Phone Number

Relationship

Method of Disposition

Cemetery Information (if applicable)

Name as it should appear on printed materials (ie. Prayer Cards) if different from legal name is different

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