Contact Person
Name*
First Middle Last
Address*
Street Address City State ZIP Code
Email
Phone*
Cell Phone
Work Phone
Relationship to Deceased*
Are you the Legal Next of Kin?*
Deceased Person Information
Name*
First Middle Last
Sex*
Date of Death*
MM slash DD slash YYYY
Date of Birth*
MM slash DD slash YYYY
Birthplace: City, State, Country*
Marital Status*
Michigan does not recognize Common law Marriages or Seperations
Name of Spouse (maiden name, if wife)
In Armed Forces*
Social Security Number

The SSN is required to complete the arrangements. If you don't feel comfortable entering the information here, we will call you by telephone to retrieve the SSN.
Occupation (Job held majority of life. Please do not list Disabled or Retired)*
Kind of Business/Industry*
Elementary & Primary Education (select highest completed)*
Higher Education*
Address (Legal address of the deceased)*
Street Address City State ZIP Code
Inside City Limits?*
Race*
- White
- African American
- Hispanic
- Asian
- Native American
Ancestry/Nationality (List up to 3)
Parents
Legal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.
Father's Name*
First Middle Last
Mother's Name*
First Middle Last
Maiden*
Name
This field is for validation purposes and should be left unchanged.

Contact Person

Deceased Person Information