At Need Form

Use this form to provide us with as much or as little detail as you wish. At a minimum, provide us with details from the fields in * and give us any instructions using the message box at the base of the form.

Deceased Vital Statistics for Death Certificate

* First Name: * Last Name:
Middle Name:
Sex: Race:
Date of Birth:
City of Death:
State of Death: Country of Death:
Location of Death:
If other, please indicate address:
Name of the Place of Death: Education
Usual Occupation (most of life) : Kind of Business:
Marital Status:
Full Name of Surviving Spouse: If Wife, Provide Maiden Name:
Residence - Street Address: City/Town:
Inside City Limits: State:
Zip Code: Country:
Length of Residence In Country:
Father's Full Name:
Mother's Full Maiden Name:

Type of Disposition

Disposition Will Be:
If Cremation, Indicate Preference For
Disposition of Ashes?:
Name of Cemetery (if applicable):

Preparation and Viewing

Important Note: Viewing of the body is a choice of the family. In most cases, embalming is required or recommended for public viewing/visitation, mausoleum entombment, or transfer of remains via common carrier (i.e. shipment by air or rail). When possible, the funeral home needs authorization from the next of kin for embalming.
Except in certain cases, embalming is not required by law. Embalming may be necessary, however, if you select certain funeral arrangements, such as a funeral with viewing. If you do not want embalming, you usually have the right to choose an arrangement, which does not require you to pay for it, such as a direct cremation, immediate burial and/or one-time ID viewing for family only. If you elect NOT to order embalming, State law requires refrigeration of an unembalmed body that is held for over 24 hours from the time of death.
The Family Preference Regarding Viewing/Embalming Is:
I Authorize Frech Funeral Home To Embalm:
Name of Authorizing Person:
Relationship To Deceased:

Veteran Information

Was Decedent Ever In the US Armed Forces?:
Branch of Service:
Date Enlisted:
Date Discharged:
Honorable Discharge:
Military Serial Number:
Is A Copy of Discharge Papers Available?

Informant/Person In Charge Information

* First Name: * Last Name:
Relationship To Deceased: * Email Address:
Address: City:
State: Zip Code:
Telephone Number:

Funeral/Memorial Service Information

Preferred Place of Service: Religious Denomination:
Is there Immediate Need Funeral Insurance on decedent?:
If Yes, Specify Insurance Type: (i.e., Forethought, Purple Cross, trust, etc.)

Other Information & Instructions

Please list any other instruction or information you would like us to have: