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Family Owned. Family Focused.

1-610-750-5057

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Home
Cremation Forms
Urns and Jewelry
- Urns
- Finger Print Jewelry
Obituaries
About Us
Location
Questions

At-Need Form - Use this form if a death has occurred.

If a Death has occurred, please call us first at 610-750-5057, then complete the information below.

Please note: The information you type here will be used on legal documents. How you type the word is exactly how it will appear on all legal documents. Therefore, please do not abbreviate words, spell correctly using proper capitalization and type full names or middle initials on everyone as-well as complete addresses. If a questions is left blank it will appear as "unrecorded" on the death certificate. If you do not know an answer, please type "unknown" in the space.

1) After completing the questions on this form, click on the "submit" button on the bottom right of this page.

2) Click on the "Cremation Forms" tab above, and complete the "Cremation Authorization" form too.

We will call you after the cremation has been performed to arrange a time to meet so you can receive everything.

We are a Direct Cremation Provider, we Do Not Provided an opportunity for a viewing before Cremation.

Reading Cremation Society Vital Statistics for Death Certificate

Deceased's Information

Full Name of Deceased (First, Middle Initial, Last Name)

Street

City

State/Province

ZIP/Postcode

Day, Date and Time of when Deceased Passed away

Location where Deceased passed away (Name and Address of Hospital, Nursing Home, etc.)

Which Borough or Township did Deceased live?

Deceased's Social Security Number

Deceased's Date of Birth

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

Was Deceased of Hispanic Origin?

NoHispanicPuerto RicanMexicanOtherUnknown

Is Deceased Male or Female?

Family Information

Deceased's Father's Name

Deceased's Mother's Name

Deceased's Mother's Maiden Name

Deceased's Marital Status

Deceased Self Described Race

WhiteAfrican AmericanOther

Deceased's Spouse's Name (If Applicable)

Deceased's Spouse's Maiden 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 Occupation (Job title for majority of working career. Do not use retired or unemployed)

Company Name Deceased worked at longest

Business Field (Manufacturing/Service/Sales, etc.)

Military Experience

Did Deceased serve in the military?

YesNo

Branch of Service

Date Entered Service

Date Discharged

Serial Number

Rank at Discharge

Do you have a copy of the Deceased's discharge papers? If so, please up-load a copy.

YesNo

Next-of-Kin

Name of Person Legally in Charge of Cremation Arrangements. (spouse, child, sibling, etc.)

Relationship to Deceased

Street address of Person in Charge

City / State / Zip of Person in Charge

Telephone Number of Person in Charge

Email Address of Person in Charge

Extra's

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

2) Urn Options

All Cremated Remains are returned in a corrugated fiberboard Urn unless another is selected. Click on the link below to up-load our Urn Catalog by Matthews Urns in Pittsburgh, PA

https://mywebsite.matthewsaurora.com/MobileCatalog/

Urn SelectionUse this space to type in the name of the urn you would like us to order.

3) Memorial Stationary Options

Click on the graphic on the left to download and View all of our Memorial Stationary Products. We offer Guest Register Books, Memorial Folders, Prayer Cards, Thank you cards, Memorial D.V.D.'s and Memory Candles.

Memorial Stationary SelectionUse this space to type in the name(s) of the Stationary and prayer you would like us to have printed.

4) Finger Print Cremation Jewelry

Click on the link below to view our Finger Print Cremation Jewelry. If you wish to order jewelry, you MUST let us know so we can obtain a set of prints prior to the cremation. We will also assign you a PIN number at that time.

https://legacytouch.com/slideshow

5) Send us a FileAttach a file such as an Obituary, a picture, DD-214 Military Discharge, the prayer for a memorial folder, etc.

6) Use this space to provide us with any additional information or questions you may have.

After you press the "Submit Information" tab (Below) please complete the "Cremation Authorization" by clicking on the "Cremation Forms" tab at the top of this page.

Mark A. McCarter, Supervisor