McCafferty Funeral & Cremation Inc.
This form is used to obtain information needed for the death certificate and funeral arrangements.
Email address *
Name of Deceased *
Decedent's Address
Approximate Height and Weight of Deceased *
Clear selection
Date of Birth
City of Birth
State of Birth
County of Birth
Country of Birth
Date of Death
Place of Death (Name or Address)
Decedent of Hispanic Origin
Social Security #
Education Level
Occupation (what did they do for most of their lives?) *
Industry *
Decedent's Father's Name
Decedent's Mother's First Name and Maiden Name
Clear selection
If Veteran, Branch of Service
Marital Status
(If Married) Husband's Name / Wife's First Name and Maiden Name
Next of Kin's Full Name
Next of Kin's Address
Next of Kin's Phone #
How did you find us? *
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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