Basic Information Form

PART A     INFORMATION ABOUT THE DECEDENT

Name (first, middle, last)

Gender

Please Select Female Male

Date of Birth (month/day/year)

Social Security Number

Usual Occupation (give kind of work done during most of working life)

Kind of Business or Industry

Current Residence Address

Locality

Please Select city or village of: township of:

City

Please Select Grand Rapids Wyoming Kentwood Grandville Lowell Comstock Park Other (specify)  If other:

County

State

Zip Code

Mailing Address (if different from above)

Street and number or rural route number, city or village, state, zip code.

Birthplace (City and State or Foreign Country)

Marital Status

Please Select married never married widowed divorced

Surviving Spouse (if wife, give name before first married)

Was decedent ever in US Armed Forces?

Please Select yes no

Hispanic Origin

Please Select Yes No

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.

Decedents Education
(Specify highest grade completed)

Please Select 0 1 2 3 4 5 6 7 8 9 10 11 12 1 year college 2 years college 3 years college 4 years college 5+ years college

Father's Name (first, middle last)

Mother's Name
(first, middle, surname before first married)

PART B     FUNERAL SERVICE   -GENERAL QUESTIONS

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

Please Select my church or other facility Memorial Alternatives Chapel

What Clegy is to Officiate?

If Burial, what cemetery?

no selection Fulton Street Oakhill Restlawn Rosedale Woodlawn Greenwood Plainfield Township Holy Cross Resurrection other  Other

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

Family to pick up.
Mailed to ($30 CONUS mailing fee applies):
Name, Mailing Address
Deliver to Local Cemetery (no charge for local cemetery delivery):

Other (inicate):

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)

PART C     FUNERAL SERVICE  -SPECIFIC QUESTIONS

I am interested in:
(To review merchandise in a new window, click Burial Packages or Cremation Packages)

Burial
Packages: no selection Burial Value Package Final Tribute Deluxe Burial Package Immediate Burial Immediate Burial at Fort Custer
Cremation
Packages: no selection Complete Funeral Followed by Cremation Time to Say Goodbye Package Immediate Cremation Immediate Cremation with Memorial Service
   Urn and/or urn 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 #, email address:

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

Please just keep this information on file for now.

Email address (we will confirm receipt of this form):

For information on prepaying for your funeral services, see our pre-arrange 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.

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