Hidden

Your Information

Name(Required)

Deceased's Information

MM slash DD slash YYYY
Death Time
:

Did the death occur from a disease declared by the Department of Health and Human Services to be infectious, contagious, communicable, or dangerous to the public health?

Did the death occur from

Check any that are present in body of the deceased:

Did the death occur from

All pacemakers, prostheses, plastic casts, and radioactive implants must be removed prior to delivering the deceased to the crematory.

Eventually the cremated remains will be interred or inurned in a cemetery or will be scattered:

Did the death occur from

Deceased will be transported to Oak Grove Crematory in the following type of container/casket:

Did the death occur from

All pacemakers, prostheses, plastic casts, and radioactive implants must be removed prior to delivering the deceased to the crematory.

If the cremated remains are not being interred at the cemetery, then the staff at the crematory is requested by the authorizing person to make the following disposition of the cremated remains:

Ship by registered mail to
deliver by vehicle before
MM slash DD slash YYYY
Death Time
:
to funeral establishment to
pick up at Oak Grove Crematory