Home What To Do When Death Occurs Crematory Direct Package Registration Requirements Contact Us 415 S.Henderson StreetFort Worth, TX 76104Office: (817)877-1777Fax: (817)335-4313info@crematorydirect.net Registration Step 1 of 8 12% 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 selectMarriedWidowedDivorcedNever marriedFather'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 select8TH GRADE OR LESS9TH – 12TH GRADE, NO DIPLOMAHIGH SCHOOL GRADUATE OR GED COMPLETEDSOME COLLEGE CREDIT, BUT NOT A DEGREEASSOCIATE 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)UNKNOWNType of Industry*Decedent Occupation: Give the type of work done most of working life, even if retired.*Was decedent ever in law enforcement?*YesNoDid decedent serve in the military?*YesNoIf yes, what branch? Decedent of Hispanic Origin?*Please selectNo, not Spanish/Hispanic/LatinoYes, Mexican American/ChicanoYes, Puerto RicanYes, Yes, CubanYes, Other Spanish/Hispanic/LatinoSpecifyPlease enter Survivor Information belowSurviving Spouse’s Name – If wife, enter Maiden Last Name.SonsDaughters ParentsBrothersSistersGrandparents GrandchildrenExtended Family Name*Address*City*Is address within city limits*State/Province*What county does this address fall in?*Zip/Postal Code*Phone*