610-750-5057

2741 N. 5th Street

Reading, PA 19605

(610) 750-5057

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If a Death has just occurred, please call us first at (610) 750-5057.

Please complete the information below, when completed, click submit. Please note: All questions must be answered, or type "unknown" in the space. The absence of information will delay or postpone the cremation.

Click HERE to view our complete Direct Cremation Services and Fees. If any additional services are requested by you or are required as a result of the Decedents Care and Cremation, the additional fee(s), if any, will be added to this base price for the Cremation.

Deceased Information.

INFORMATON ON THE DECEASED

First Name of Deceased

Middle Initial

Last Name of Deceased

Street

City

State/Province

ZIP/Postcode

If the Deceased lived outside a City or Borough limit, if so specify.The State wants to know exactly where the Deceased's residence physically rests. Is the house inside the City or Borough limit, or does it sit inside a Township Limit?

Date of when Deceased Passed away.

Name of Institution or address of residence where Deceased passed away.

Deceased's Self Described Gender.

FemaleMaleUnknownOther

Deceased's Social Security Number. (Required on all legal documents)Please Note: We will not obtain certified copies of the death certificate for you without the social security number, unless you specifically tell us to do so. The reason being, most institutions will not accept a Death Certificate without the social security number on it for business transactions.

Deceased's Date of Birth.

Deceased's Place of Birth. (City, County, State, Country)

Was Deceased of Hispanic Origin?

Yes, Mexican, Mexican American, Chicano

Yes, Puerto Rican

Yes, Cuban

Yes, Spanish

Yes, Hispanic

Yes, Latino

Deceased's Self Described Race.

White

African American

American Indian or Alaska Native

Asian Indian

Chinese

Fillpino

Japanese

Korean

Vietnamese

Other Asian

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

Other

INFORMATION ON THE FAMILY

Deceased's Marital Status.If you are separated, you are still legally married in PA. Pennsylvania does not recognize common law marriages that were contracted after Jan. 1, 2005.)

Deceased's Spouse's FIRST Name. (Only If currently Married and living.)

Deceased's Spouse's MIDDLE Initial. (If Married)

Deceased's Spouse's LAST Name. (If Married)

Deceased's Spouse's Maiden Name. (If Married)

Deceased's Father's FIRST Name.

Deceased's Father's LAST Name.

Deceased's Mother's FIRST Name.

What was the Deceased's Mother's MAIDEN Name?

What was the Deceased's Mother's Last (Current Married) Name?

EDUCATIONAL LEVEL

Deceased's Highest Level of Education Attained.

Attended Grade-School (1-8)

Attended High-School (9-12)

Graduated High School /or G.E.D. (12)

Attended one Year of College

Associate's Degree

Bachelor's Degree

Masters-Degree

Doctorate

WORK HISTORY

Deceased's Job Title. (Occupation for majority of working career) - Not Retired.

Deceased's Work Field. (Manufacturing/Sales/Service, etc.) Specify.

MILITARY SERVICE

Did Deceased serve in the military?

YesNo

NEXT-OF-KIN

Typed Signature of Person legally in charge of these arrangements.(This typed signature constitutes your hand-written signature. Only one name and one address should appear here.)

Relationship to Deceased.

Street Address of Person in Charge. (Do not use P.O. Box)

City or Town of Person in Charge.

State of Residence of Person in Charge.

Zip Code of Person in Charge.

Telephone Number of Person in Charge.

Email Address of Person in Charge.

EXTRA'S (Optional)

How many Certified Copies of the Death Certificate do you need? ($ 20 per copy)

We recommend 5 copes (at most) to start. You can always order more by Clicking on the "Order More Death Certificates" tab in the middle of the Home Page.

Would you like to view our Urn/Jewelry Booklet?

Click on the graphic on the left to download our Urns & Cremation Jewelry Catalog.

If you choose an Urn (above our standard urn) record the Information here.If you selected an Urn, type the name, page number and code number of the urn here. Not every urn is engravable, but if so, do you wish to have the urn engraved with the Deceased's name and dates? (All engravable urns are marked with a "Pencil Point". Engravable fonts can be found on page 5.

Use this space for any additional information or questions you may have.

Legal Authorization

By checking this box: A) I attest to the information submitted here in is legally true and correct to the best of my knowledge; B) As the Legal Authorized Appointed Representative of the Deceased I instruct and authorize the Reading Cremation Society to perform the cremation without delay or further notification but according to their schedule after receipt of all legal authorizations required by the Commonwealth of PA and the County where the Deceased died; C) I attest that I have read and agree to the Cremation Authorization and understand the Process as described in the Cremation Authorization Form on this website; D) I have read understand and agree to the explanation of prices to perform this service under the Price tab on the homepage.

Payment:

Cash

Check

Credit Card or Debit Card A 375 fee will be added to all Credit and Debit Card transactions This fee is imposed upon us by the credit card companies

Payment in Full is required after everything is complete and when you come to our office to receive the Cremated Remains and Death Certificates.

PLEASE READ THROUGHLY

Prior to clicking on the Submit Button below, go back and double check all of your work. Make sure each entry is complete and all names and dates are true and spelled correctly. Errors in submissions can be fixed but take six to eight weeks to obtain new death certificates at a cost of $ 20 per new certificate and $ 100. process fee, so, Please double check your answers.

Once you click "Submit" a pop-up window will appear, at the top of this page, confirming our receipt of your information. If you did not receive that notice, at the top of this page, go back and double check any questions that are highlighted in Red. The pop-up notice may not appear on all hand-held devices. A Funeral Director will call you after everything is ready to be received at our office to arrange a time to get together.

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