McCafferty Funeral & Cremation Inc.
This form is used to obtain information needed for the death certificate and funeral arrangements.
Email address *
Name of Deceased *
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Decedent's Address
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Age
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Approximate Height and Weight of Deceased
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Sex
Date of Birth
MM
/
DD
/
YYYY
City of Birth
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County of Birth
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Country of Birth
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Date of Death
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/
DD
/
YYYY
Place of Death (Name or Address)
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Race
Decedent of Hispanic Origin
Social Security #
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Education Level
Occupation
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Industry
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Father's Name
Your answer
Mother's First Name and Maiden Name
Your answer
Veteran
If Veteran, Branch of Service
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Marital Status
(If Married) Husband's Name / Wife's First Name and Maiden Name
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Next of Kin's Full Name
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Next of Kin's Address
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Relationship
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Next of Kin's Phone #
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By checking below I understand that the information in this form is correct and that this information will be used on the death certificate and all necessary documents pertaining to the funeral arrangements for the person listed above. *
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