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Our Process
Location
Services
Merchandise
Financial Assistance
Obituaries
- Obituary Listings
- Obituary Notifications
Reviews
Contact Us
Blog

Start Planning

This information is required for the completion of the death certiﬁcate and other legal forms. It is not associated with the obituary.

Start Planning

Type of Arrangement

Select Type of Arrangement Needed*

Type of Arrangement

Loved one has passed (Immediate Need)

Pre-Plan for the future (Keep my Information on File)

Pre-Fund for the future (Open a Revocable or Irrevocable Trust)

Service Types

Service Types*

Service Types

Simple Cremation

Simple Cremation with a Graveside Service

Simple Cremation with a Final Goodbye

Anatomical Gift

__________________________________________________

Date of Death (not required when planning ahead)

Place of Death (Facility or Residential Address)*

__________________________________________________

Legal Information of Decedent*

Legal Information (of Decedent or person planning ahead)

First Name*

Middle Name*

Last Name*

Name Suffix

Sex*

Male

Female

Date of Birth*

Age

City of Birth*

State / Province / Region of Birth*

Country of Birth*

__________________________________________________

Veteran Heading

Veteran Information

Did this individual ever serve in the armed forces?*

Yes

No

What Branch of Service?

Army (Air Corp)

Marine Corps

Navy

Coast Guard

Air Force

Other

If other please specify below

__________________________________________________

Origin Heading

Hispanic Origin / Race / Education / Marital Status

Hispanic Origin (Check the box that applies)

No, Not Spanish/Hispanic/Latino

Yes, Cuban

Yes, Puerto Rican

Yes, Mexican, Mexican American

Other

Race (Check the box that best applies)

White/Caucasian

Asian

Black or African American

Other

If other, please specify below

__________________________________________________

Education (Check the box that best describes the highest degree or level of school completed)*

8th grade

9th-12th grade, no diploma

High school graduate or GED

Some college credit, but no degree

Associate’s degree

Bachelor’s degree

Master’s degree

Doctorate or Professional degree

__________________________________________________

Marital Status*

Never Married

Married

Widowed

Divorced

Separated

Surviving Spouse (If wife, First and Last maiden name)

__________________________________________________

Occupation Heading

Occupation

Most Recent Occupation (Do not enter retired)*

Place of Employment (Last or longest)

Type of Business or Industry

City of Employer

State of Employer

__________________________________________________

Current Address Heading

Current Address/Residence (of Decedent)*

Name of Facility of current address (If not facility, give address)*

Street Address*

City*

State*

Zip Code*

__________________________________________________

Parents Heading

Parents

Father Heading

Father

Father's First Name

Father's Last Name

Mother Heading

Mother

Mother's First Name

Mother's Last (Maiden) Name

__________________________________________________

Informant Heading

Informant/Next of Kin

(Surviving spouse or person in charge of arrangements)

Next of Kin's First Name*

Next of Kin's Last Name*

Relationship to Deceased*

Street Address*

City *

State *

Zip Code *

Email*

Phone*

__________________________________________________

Comments Heading

Additional Comments or Questions

Enter Comments or Questions

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Rochester Cremation

Start Planning

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