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Basic Information Form

This form consists of 4 parts. It includes most of the information needed to make funeral arrangements for yourself or another. Much of the information is required for legal documents, such as the death certificate. Other information helps you decide what type of funeral you would like.

You may print this form blank, or after you have filled all or part of it in, you may also submit the form online.

By law, cremation requires the signatures of all closest next of kin. The Cremation Authorization Form is available here.

Note: Memorial Alternatives will place an obituary in the Grand Rapids Press (additional charge). All other newspaper obituaries should be handled directly by the family.

Part A - Information About the Decedent

Name (First, Middle, Last)

Gender

MaleFemale

Date of Birth

Usual Occupation (Work done most of working life)

Kind of Business or Industry

Residence Address

Street

City

State/Province

ZIP/Postcode

Locality

County

Mailing Address (if different from above)

Street

City

State/Province

ZIP/Postcode

Birthplace (City and State or Foreign Country)

Marital Status

Was Decedent Ever in US Armed Forces?

YesNo

Surviving Spouse (if wife, give maiden name)

Ancestry (Mexican, Puerto Rican, Cuban, Central or South American, Chicano, other Hispanic, Afro-American, Arab, English, French, Finnish, etc.)

Race (American Indian, Black, White, etc. If Asian, give nationality i.e., Chinese, Filipino, Asian Indian, etc.)

Hispanic Origin?

YesNo

Decedent's Education (Specify highest grade completed)

Father's Name (First, Middle, Last)

Mother's Name (First, Middle, Maiden Name)

Part B - Funeral Service - General Questions

If a funeral or memorial service is selected, where is it to be held?

My Church or Other Facility

Memorial Alternatives Chapel

What Clergy is to Officiate?

If Burial, What Cemetery?

If Other, Please Specify

If Cremation is selected, what should be done with the cremains?

Family to pick up

Mail - Contiguous US only, postage and fees apply

Deliver to local cemetery at our convenience, no charge

Other

If Mailed, list Name and Mailing Address

If Delivery, Name of Local Cemetery

If Other, Please Specify

Please List at least 2 Survivors (Name, Relationship, Address, Phone number)

Person to Finalize Arrangements at Time of Death (Name, Relationship, Address, Phone number)

Number of Death Certificates Needed to Settle Legal Affairs (Kent County charges $10 for the first and $3 for each additional - pricing varies by county)

Part C - Funeral Service - Specific Questions

I am Interested In:

Burial Packages

Cremation Packages

Click Here to view Burial Packages

I Want This Burial Package

Click Here to view Cremation Packages

I Want This Cremation Package

Urn or Vault Selected

Packages may be upgraded. If desired, indicate the casket and/or vault you would like:

I don´t want a package, I want:

Part D - Final Form Information

If cremation is selected, all of the closest next of kin need to fill out the Cremation Authorization Form. This form can be viewed and/or downloaded here.

If someone other than the person the funeral arrangements are for is completing this form, provide name, address, relationship, phone number, email:

What to do with this form

Please call me to finalize the arrangements My phone number is listed below.

Please just keep this information on file for now.

Point of Contact

Telephone

Email Address (We will confirm receipt of this form)

For information on prepaying for your funeral services, see our Pre-arrangement page.

If you prefer to sit down and talk with a counselor, please email or call for an appointment. Our phone number is (616) 363-3700. We are in the office Mondays through Fridays, 9am to 4:30pm.

Click “Submit” below to send this form to us. You may care to scroll up and review your input at this time. You can edit any entry individually. To print the form with your entries, click your browser's print button.

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