Electronic Cremation Notification
New: Upon successfully submitting this form you are clear to proceed and have fulfilled the requirements for notifying the Madison County Coroner. 

We do not issue any other documentation or provide permit numbers. You may print a copy of this form for your records and we will attempt to email you a copy of your submission but when you submit the notification, all requirements are met and you are approved to proceed in accordance with Alabama law. If you want to view the confirmation message, please scroll back up to the top of the page after you press submit. 

Sign in to Google to save your progress. Learn more
Email *
Decedent's First Name *
Decedent's Last Name  *
Date of Birth  *
Date of Death *
Time Pronounced  *
Funeral Home Submitting *
Funeral Home Representative Submitting Notification  *
Type of Death Case  *
Notification is Completed with Submission 
Upon clicking the "submit" button below, your notification will be completed & you are cleared to proceed for cremation in terms of the requirement to notify the coroner. This does not waive or exempt any Alabama law as to cremation but satisfies the coroner notification/approval requirement. You will not receive an email or further communication indicating approval because the successful submission is now indicative of such approval. We will attempt to email a copy of your submission.
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy