Available 24/7: (518) 435-8030

Vital Statistics Form

Client's Information
>
Order Death Certificates
>
Return of the Ashes Following Cremation:
>
Additional Information Needed
>
Conclusion

For Immediate Assistance

Please Call: 518-435-8030

When Do You Need Our Service?*:

Your Name*:

Your Address*:

Your Telephone Number*:

Your Email *:

Specify Your Relationship to the Client*:

Full Legal Name (For Whom this Plan is For)*:

Gender*:

Date of Birth*:

Age*:

Place of Birth (City/State)*:

Veteran Status*:

For Veterans: Please Upload DD-214:

Hispanic Origin*:

Race*:

Education*:

Social Security Number*:

Marital Status*:

Surviving Spouse's Full Name (Include Maiden):

Usual Occupation (Do Not Enter Retired)*:

Kind of Business or Industry*:

Name of Employer / City & State*:

Client's Residence (Street Address, City, State, Zip) (No PO Boxes)*:

Birth Name of Father/Parent*:

Birth Name of Mother/Parent (Maiden)*:

Informant's Name (Person Arranging Services)*:

Informant's Mailing Address*:

Informant's Telephone *:

Informant's Email *:

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218 2nd Avenue
Troy, NY 12180

Directions to our Location

(518) 435-8030

Contact Us

Simple Cremations,

Service Beyond Expectation.

Vital Statistics Form

Client's Information

Order Death Certificates

Return of the Ashes Following Cremation:

Additional Information Needed

Conclusion

Simple Cremations,

​Service Beyond Expectation.

Vital Statistics Form

Client's Information

Order Death Certificates

Return of the Ashes Following Cremation:

Additional Information Needed

Conclusion

Service Beyond Expectation.