Eastern PA Cremation Services

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DECEASED'S INFORMATION

Last Name and Suffix

Deceased's Social Security Number

Deceased's Date of Death

Deceased's Date of Birth

Deceased's - Place of Birth - City, Township, or Borough

Deceased's Most Recent Street Address (No P.O. Box)

City, Twp or Boro of Residence

#1 Spouse's Full Name (Maiden Name) Date of Birth and Death (If Applicable)

Marital Status to #1 Select One

Spouse #1 Veteran? Select One

#2 Spouse's Full Name (Maiden Name) Date of Birth and Death (If Applicable)

Marital Status to #2 Select One

Spouse #2 Veteran? Select One

Additional Spousal Information

Father's Name - Last, First and Middle

Father's Address if Living

Mother's Name - Last, First and Middle

Mother's Address if Living

Mother's Maiden Name

Additional Parental Information

Full Street Address of place of death

City, Twp., or Boro of the place of death

Is the deceased Hispanic?

Race (Select only one)

If more than one race, list

If other Hispanic Origin

If other race not listed

Usual Occupation - Type of work done most of their working life.

Kind/Type of Business or Industry Worked

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Serial Number and Rank at Discharge

Upload a family written obituary

Choose File

Upload a photo of the deceased (Optional)

Choose File

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PERSONAL INFORMATION OF PERSON LEGALLY RESPONSIBLE FOR DISPOSITION

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In order to qualify as legal next-of-kin in this situation, the person must be over 18 years old. The order of kinship is listed below:

1) Spouse

2) Children

3) Parents

4) Siblings

5) Authorized Guardian

6) Grandchildren

7) Great Grandchildren

8) Nieces and Nephews

9) Grand-nieces and Grand-nephews

10) Grandparents

11) Aunts and Uncles

12) First cousins

I AM THE LEGAL NEXT OF KIN AND ABLE TO MAKE ARRANGEMENTS

Yes

Not Sure

Person in Charge - Legal Next of Kin

Relationship to Deceased

Upload Drivers License, ID or Passport

Choose File

Person in Charge - Full Address

Person in Charge Telephone

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PREARRANGED?

Are there Prearrangement on File with us?

Yes

Unknown

Was the prearrangement Paid in Full?

Yes

Unknown

Upload a copy of the Check or front and back of Credit Card

Choose File

Additional Information or Instructions

Upload any additional forms or documents you find necessary

Upload File

Selections

SELECTIONS

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You may also add pictures of your loved one to accompany the obituary. Obituary and picture(s) must be emailed to us at easternpacremation@gmail.com

I am emailing photos and the obituary

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Begin Arrangements

Veterans Package

At Need