Contact PersonName* First Middle Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Phone*Cell PhoneWork PhoneRelationship to Deceased* Are you the Legal Next of Kin?*YesNoDeceased Person InformationName* First Middle Last Sex*MaleFemaleDate of Death* MM slash DD slash YYYY Date of Birth* MM slash DD slash YYYY Birthplace: City, State, Country* Marital Status*MarriedNever MarriedWidowedDivorcedMichigan does not recognize Common law Marriages or SeperationsName of Spouse (maiden name, if wife) In Armed Forces*YesNoSocial 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.Usual Occupation (Please do not list Disabled or Retired)* Kind of Business/Industry* Elementary & Primary Education (select highest completed)*123456789101112Higher Education*NoneSome College CreditAssociates DegreeBachelors DegreeMasters DegreeDoctorateAddress (Legal address of the deceased)* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Inside City Limits?*YesNoRace* White African American Hispanic Asian Native American Ancestry/Nationality (List up to 3)ParentsLegal 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 PhoneThis field is for validation purposes and should be left unchanged.
