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415 S. Henderson Street
(817) 877-1777
What To Do When A Death Occurs
Registration
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What To Do When A Death Occurs
Registration
Crematory Direct Package
Requirements
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(817) 877-1777
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Required Fields: If you are unsure about something to put in the text field, please enter either unknown or unavailable at this time in the blank.
Decedent First Name
*
Decedent Middle Name
*
Decedent Last Name
*
Decedent Date of Birth
*
Decedent Address
*
Decedent City
*
Decedent - Is address within city limits
*
Decedent State/Province
*
Decedent - What county does this address fall in?
*
Decedent Zip/Postal Code
*
Decedent Family Phone
*
Decedent Social Security Number
*
Decedent Marital Status
*
Please select
Married
Widowed
Divorced
Never married
Father's Full Name
*
Mother’s Name Prior to First Marriage (Maiden Name)
*
City of Decedent's Birth
*
State/Province and Country of Decedent's Birth
*
Highest Level of Education of Decedent
*
Please select
8TH GRADE OR LESS
9TH – 12TH GRADE, NO DIPLOMA
HIGH SCHOOL GRADUATE OR GED COMPLETED
SOME COLLEGE CREDIT, BUT NOT A DEGREE
ASSOCIATE DEGREE (AA, AS)
BACHELOR’S DEGREE (BA, AB, BS)
MASTER’S DEGREE (MA, MS, MENG, MED, MSW, MBA)
DOCTORATE (PHD, EDD), PROFESSIONAL (MD, DDS, DVM, LLB, JD)
UNKNOWN
Type of Industry
*
Decedent Occupation: Give the type of work done most of working life, even if retired.
*
Was decedent ever in law enforcement?
*
Yes
No
Did decedent serve in the military?
*
Yes
No
If yes, what branch?
Decedent of Hispanic Origin?
*
Please select
No, not Spanish/Hispanic/Latino
Yes, Mexican American/Chicano
Yes, Puerto Rican
Yes, Yes, Cuban
Yes, Other Spanish/Hispanic/Latino
Specify
Please enter Survivor Information below
Surviving Spouse’s Name – If wife, enter Maiden Last Name.
Sons
Daughters
Parents
Brothers
Sisters
Grandparents
Grandchildren
Extended Family
Name
*
Address
*
City
*
Is address within city limits
*
State/Province
*
What county does this address fall in?
*
Zip/Postal Code
*
Phone
*
