PART A INFORMATION ABOUT THE DECEDENT
Name (first, middle, last)
Date of Birth (month/day/year)
Usual Occupation (give kind of work done during most of working life)
Kind of Business or Industry
Current Residence Address
city or village of:
If other: Please Select
Mailing Address (if different from above)
Birthplace (City and State or Foreign Country)
Surviving Spouse (if wife, give name before first married)
Was decedent ever in US Armed Forces?
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)
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?
my church or other facility
Memorial Alternatives Chapel
What Clegy is to Officiate?
If Burial, what cemetery?
If Cremation is selected, what should be done with the cremains?
Family to pick up. Mailed to ($30 CONUS mailing fee applies): 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 Value Package
Deluxe Burial Package
Immediate Burial at Fort Custer
Complete Funeral Followed by Cremation
Time to Say Goodbye Package
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 donīt 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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