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At Need Arrangements Vital Statistics Form


We are very sorry for your loss and stand ready to assist you in your time of need.  If you have not already scheduled a meeting with us, please call us on 941-748-1011.

For your convenience, we have included the following form for you to complete before arriving for your conference.  We highly suggest you send us the requested information using this form.  The information requested in sections A and B is used to record your loved one's passing with the State of Florida.  Sections C and D will provide us with information regarding your plans for ceremonies, etc., allowing us to be better prepared for your conference.  When finished, click the 'Submit Information' button below.  We understand that you may not have immediate access to all of the details (or would prefer to provide in person).  You are welcome to fill out as much or as little as you prefer.  We will cover the remainder when we meet with you.

Vital Statistics

Complete the Comments box above only if you need to supply specifics on Origin or Race

If unable to establish City of birth at this time, please be sure to have this information available during the Arrangement Conference

If you choose not to provide the SS Number at this time, you must bring it with you to the Arrangement Conference.

If unable to establish the highest level of education attained at this time, please be sure to have this information available at the Arrangement Conference

If no, continue to Employment History
Discharge papers (Form DD214) are required for applying for Veterans benefits, including burial/inurnment in a Veterans Cemetery. Please make every effort to bring a copy of the decedent's discharge papers to the Arrangement Conference.

Anticipated Ceremonies

Please provide contract number if possible.

Please list memorials or charitable donations that you'd like listed in the obituary
Use the area above to provide additional information or instructions to us.

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