Online Cremation Form

Unless previously authorized by the Deceased, in accordance with applicable state law, no cremation may take place without written authorization from the next of kin of the Deceased or the Deceased legal representative. The next of kin is the person(s) described below in the following order:

a) Surviving Spouse

b) Surviving Children

c) Surviving Parents

d) Surviving Brothers and Sisters

e) Surviving Uncles and Aunts

f) Surviving First Cousins, etc.

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If you do not know an answer, please type UNKNOWN.

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Deceased First Name:

Deceased Last Name:

Age:

Date of Death:

Deceased Address:

City:

State:

Zip Code:

New Field:

Primary Doctor or Doctor Providing Care Name:

Doctor's Telephone Number:

Manner of Death (if known):

Sex:

Race:

Ethnic Heritage:

Citizen Status:

City and State of Birth or Country if not the US:

Date of Birth:

Father's Name:

New Field:

Mother's Name (with Maiden if applicable):

New Field:

Martial Status:

Surviving Spouse Name (with Maiden if Applicable):

New Field:

Occupation Most of Life:

Industry That Occupation is in:

Social Security Number:

Highest Education Level Completed:

Served in Military? If yes, what branch or war?

Name of Person Providing This Information:

New Field:

Address of Person Providing Information:

City:

State:

Zip Code:

Phone Number of Person Providing This Information:

Email of Person Providing This Information:

Surviving Children's Names and Ages:

Surviving Brothers & Sisters Names and Ages:

Do you wish for us to place a death announcement in the local newspapers or on our website?

Yes

Online Cremation Form

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If you do not know an answer, please type UNKNOWN.

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Mullins Memorial

A Year of Grief Support

Online Cremation Form

All fields require a response.If you do not know an answer, please type UNKNOWN.

Contact Us

Mullins Memorial

A Year of Grief Support

All fields require a response.
If you do not know an answer, please type UNKNOWN.