At-Need Form

*Vital Stats Online Form* Please fill in the information below for the person the plan is for
First Name
Middle Name
Last Name
Street Address
City or Township
County
State
Zip Code
Highest Grade Completed
Date of Birth
Birthplace (City, State)
Name of Spouse (if wife use maiden)
Marital Status
Date of Marriage
Marriage Place (City, State)
Occupation
Industry
Father's Name
Mother's Name (Use maiden name)
Cemetery
Cemetery City
Cemetery County
Cemetery State
Military Information (Remember to bring in, or email copy of DD-214)
Veteran (Yes or No)
Branch
War
Date of Entry
Date of Separation
Rank
Serial Number
Claim Number
Receiving Benefits from the VA?
*Informant's Information (person who will be in charge of planning the arrangments)*
Informant
Relationship
Informant Mailing Address
Informant City
Informant State
Informant Zip
Informant Phone
Informant Email
*Service Information*
Service Type
Disposition
Service Time
Service Date
Service Place
Visitation Hours
Visitation Date
Visitation Place
Minister

*The following is needed if you would like an obituary in the newspaper***
List Surviving Family Members


List Family Members who preceded in death


Hobbies and Clubs