Pre-Arrangement Form

Your Information

Full Name*:

Mailing Information

Address*:

 

City*:

Country*:

State/Province*:

Zip/Postal code*:

Email Address*:

Phone Number:

Date of Birth:

City of Birth:

State of Birth:

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Spouse's Information

Marital Status:

 Never Married

 Married

 Separated

 Divorced

 Widowed

 Unknown

Spouse's Name:

Spouse's Maiden Name:

Spouse's Address

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Father & Mother Information

Father's Name:

Father's City of Residence:

Mother's Name:

Mother's Maiden Name:

Mother's City of Residence:

Work & Education

Education:

1 2 3 4 5 6 7 8 9 10 11 12 College University

Your Occupation:

Kind of Business:

Company Name:

Military Information

Branch Service:

Army Air Force Coast Guard Marines Navy Other

Serial Number:

Date Enlisted:

Rank at Discharge:

Date Discharged:

Discharge on File at:

Copy of Discharge Papers:

 Yes

 No

Funeral Service Information

Place of Service:

Select One Funeral Home Church Cemetery

I Prefer the Funeral Service To Be:

Select One Public Private

Viewing for Family:

 Yes

 No

Viewing for Friends:

 Yes

 No

Religious Denomination:

Place or Worship:

Lodge or Union:

Disposition Information

I Prefer:

Select One Burial Cremation Entombment

Cemetery:

Address:

Phone:

I Have Made A Last Will & Testament:

 Yes

 No

Additional Information

Flower Preference:

Music Selections:

Casket Pallbearers:

Jewelry:

Glasses:

Clothing:

Special Instructions

Other Information:

Memorials & Charities:

Send Information

Please select one of the options below:

Send info about Pre-Need Contact to set an appointment Please keep my information on file

For Office Use Only

Office Staff Only

Open

Close

Funeral Home Information

Location

Winthrop Location

Hammill Funeral Home
653 State Highway 11C   |   Winthrop, New York 13697
Tel: (315) 389-5141   |   Fax: (315) 389-4311

St. Regis Location

Hammill Funeral Home
146 County Route 5   |   St. Regis Falls, New York 12980-0316
Tel: (518) 856-9801   |   Fax: (315) 389-4311

Funeral Home Registration #:

Funeral Director Name:

Funeral Directors Registration #:

Embalmer Name:

Embalmer Registration #:

Name & Residence

Case ID:

Suffix:

Nickname:

Maiden Name:

Address County:

Location:

 City

 Village/Borough

 Town

Within City or Village Limits:

 Yes

 No

Town:

District Name:

District Number:

Years at Residence:

Formerly of:

Place of Death

Date of Death*:

Time of Death:

Time Unknown:

 Yes

Place of Death Type:

Select Hospital Nursing Home Private Residential Other Hospice Inpatient Outpatient DOA ER

If Facility, Date Entered:

Place of Death:

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Phone Ext:

Location:

 City

 Village

 Town

County:

In City Limits:

 Yes

 No

District Name:

District Number:

Medical Record Number :

Death Registration Number:

Date Permit Issued:

Coroner Contacted:

 Yes

 No

Length of Illness:

Cause of Death:

Was Decedent Transferred:

 Yes

 No

Date Entered:

Institution:

City:

State:

County:

History

County of Birth:

Country:

Select USA Other

Social Security Number:

 

Ethnic Origin

Race:

 Asian Indian

 Arabic

 Black

 Chinese

 Filipino

 Guamanian

 Hawaiian

 Indian

 Japanese

 Korean

 Native American or AlaskaNative

 Samoan

 Vietnamese

 White

 Other

Deceased Hispanic?

Yes

No

Hispanic Origin Type:

 Chicano

 Cuban

 Mexican

 Mexican American

 Puerto Rican

 Other

Education & Occupation

Education Information Required?

Yes

No

Education Years:

College:

Education Notes:

Occupation Informant Required?

Yes

No

Number of Years:

Retired:

Select Yes No

Year Retired:

Work History:

Additional Military Details

Served in Armed Forces

Yes

No

Start Place:

Name of War:

Select World War I World War II Korean Vietnam Persian Gulf

Medals Awarded:

 Medal of Honor

 Dist. Service Cross

 Navy Cross

 Air Force Cross

 Bronze Star

 Silver Star

 Purple Heart

Other Medals:

VA File Number:

Honors to be rendered:

Cemetery Chapel Funeral Home Other

Veteran Marker Box

Do You Require A Veteran Marker Box

Yes

No

First Name:

Last Name:

Date Marker Ordered:

Ordered by:

Type of Marker:

Bronze Niche Flat Bronze Flat Granite Flat Marble Upright Granite

Emblem:

Aaronic Order Church Atheist Bahai 9 Point Star Buddhist Christian Christian and Missionary Alliance Christian Church Christian Reformed Church Christian Science Cross and Crown Community of Christ Eckankar Episcopal Cross Greek Cross Hindu Islamic 5 Pointed Star Judaism Konko-Kyo Faith Lutheran Cross Mormon-Angel Moroni Muslim Crescent and Star Native American Church of America None Presbyterian Cross Russian Orthodox Cross Seicho-No-Le Servian Orthodox Sufism Reoriented Tenrikyo Church The Church of World Messanity Unitarian Church Flaming Chalice United Church of Christ United Church of Religious Science United Methodist Church United Moravian Church WICCA (Penticle)

Ship To:

Funeral Home Cemetery Informant Flag Recipient

Date Received:

Date Family Called:

Who Called Family:

Date Picked Up:

Picked Up By Whom:

Notes:

Flag

Yes

No

First Name:

Middle Name:

Last Name:

Address:

Address 2:

City:

State:

Zip:

Relationship to Deceased:

Select Husband Wife Son Daughter Brother Sister Mother Father

Informant

Title:

Select Mr. Ms. Mrs. Miss

Informant First Name:

Informant Middle Name:

Informant Last Name:

Informant Maiden Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Email:

Address 1:

Address 2:

City

Country

State/Province

County:

Zip/Postal code

Phone:

Work Phone

Cell Phone

Date of Birth:

Deceased Relationship to Informant:

Letter Salutation:

Social Security Number:

Next of Kin:

 Yes

 No

Do You Require a Second Informant

Yes

No

Second Informant

Title:

Select Mr. Ms. Mrs. Miss

Informant First Name:

Informant Middle Name:

Informant Last Name:

Informant Maiden Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Email:

Address 1:

Address 2:

City

Country

State/Province

County:

Zip/Postal code

Phone:

Work Phone

Cell Phone

Date of Birth:

Letter Salutation:

Social Security Number:

Next of Kin:

 Yes

 No

Do You Require a Third Informant

Yes

No

Third Informant

Title:

Select Mr. Ms. Mrs. Miss

Informant First Name:

Informant Middle Name:

Informant Last Name:

Informant Maiden Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Email:

Address 1:

Address 2:

City

Country

State/Province

County:

Zip/Postal code

Phone:

Work Phone

Cell Phone

Date of Birth:

Letter Salutation:

Social Security Number:

Next of Kin:

 Yes

 No

Survivor

Same as Informant

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Add More Survivors?

Yes

No

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Add More Survivors?

Yes

No

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Survivor

Survivor First Name:

Survivor Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Additional Disposition Information

Method of Disposition:

Select Burial Cremation Removal Hold Donation Entombment Other

Date of Disposition:

Time of Disposition:

Place of Disposition:

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

County:

Embalming Authorized:

 Yes

 No

Notes:

Final Resting Place

If Burial, Complete Final Resting Place Section

Yes

No

Burial Permit Number:

Burial Type:

Select Burial Burial of Cremains Entombment Interment Inurnment Receiving Scattering Scattering at Sea

Same as Place of Disposition

Burial Location:

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

County:

Public / Private:

 Public

 Private

Flowers to Cemetery?:

 Yes

 No

Notes:

Grave Information

Grave Information Required?

Yes

No

Lot Owner:

Section:

Lot:

Block:

Row:

Grave:

Burial Date:

Burial Time:

Service Type

Service Type:

Select Cremation - Direct Cremation - With Service Ship In - No Service Ship In - With Service Ship Out - No Service Ship Out - With Service Social Services Traditional Youth Infant Other

Religion:

Select Christian Muslim Hindu Buddhist Sikh Jewish Other

Previously Served:

Select Yes No

Certifier

Certifier Type:

Select Attending Physician Physician acting on behalf Coroner Medical Examiner/Deputy Medical Examiner

Title:

Select Dr Mr. Ms. Mrs. Miss

First Name:

Middle Name:

Last Name:

Address 1:

Address 2:

City:

State:

Zip:

County:

Phone:

Fax:

Email:

License Number:

Autopsy Performed:

 Yes

 No

 Unknown

Autopsy Findings Used:

 Yes

 No

 Unknown

Manner of Death:

Select Natural Accidental Suicide Homicide Pending Undetermined

Pregnancy:

Not Applicable Pregnant Not Pregnant Last 42 Days

Notes:

Do You Require A Second Certifier?

Yes

No

Second Certifier

Certifier Type:

Select Attending Physician Physician acting on behalf Coroner Medical Examiner/Deputy Medical Examiner

Title:

Select Dr Mr. Ms. Mrs. Miss

First Name:

Middle Name:

Last Name:

Address 1:

Address 2:

City:

State:

Zip:

County:

Phone:

Fax:

Email:

License Number:

Notes:

Visitation Information

Event Name 1:

Description:

Start:

End:

Start date must be before end date.

Location Name:

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Private Event?:

GPS Coordinates (Optional)

Latitude:

Longitude:

Do You Require A Second Visitation?

Yes

No

Same as Event Name 1

Event Name 2:

Description:

Start:

End:

Start date must be before end date.

Location Name:

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Private Event?:

GPS Coordinates (Optional)

Latitude:

Longitude:

Do You Require A Third Visitation?

Yes

No

Same as Event Name 1 Same as Event Name 2

Event Name 3:

Description:

Start:

End:

Start date must be before end date.

Location Name:

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Private Event?:

GPS Coordinates (Optional)

Latitude:

Longitude:

Service Details

Event Name 1:

Description:

Start:

End:

Start date must be before end date.

Location Name:

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Private Event?:

GPS Coordinates (Optional)

Latitude:

Longitude:

Do You Require A Second Service?

Yes

No

Same as Event Name 1

Event Name 2:

Description:

Start:

End:

Start date must be before end date.

Location Name:

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Private Event?:

GPS Coordinates (Optional)

Latitude:

Longitude:

Do You Require A Third Service?

Yes

No

Same as Event Name 1 Same as Event Name 2

Event Name 3:

Description:

Start:

End:

Start date must be before end date.

Location Name:

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Private Event?:

GPS Coordinates (Optional)

Latitude:

Longitude:

Interment Information

Do You Require Interment Information on Memorial Website?

Yes

No

Same as Burial Location

Event Name 1:

Description:

Start:

End:

Start date must be before end date.

Location Name:

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Private Event?:

GPS Coordinates (Optional)

Latitude:

Longitude:

Future Services

Future Service Information Required?

Yes

No

Future Service Needed?:

 Yes

 No

Future Service Type:

Select Memorial Service Spring Burial

Same as Burial Location

Service Location:

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Service Time:

Service Date:

Public / Private:

 Public

 Private

Notes:

Clergy / Minister

Clergy Name:

Church :

Address:

 

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Religion:

Special Notes:

Church Requirements

Organist:

Singers/Soloist:

Choir Required?:

 Yes

 No

Song Selections:

Reading Selections:

Family Members Selected for Reading:

Flowers sent to Church?:

 Yes

 No

Charity Selection

Family Preferred Charity #1:

Family Preferred Charity #2:

Service Clubs

Name of Service Club #1:

Name of Service Club #2:

Pallbearer Information

Pallbearers Information Required?

Yes

No

Pallbearer First Name:

Pallbearer Last Name:

Pallbearer

Pallbearer First Name:

Pallbearer Last Name:

Pallbearer

Pallbearer First Name:

Pallbearer Last Name:

Pallbearer

Pallbearer First Name:

Pallbearer Last Name:

Pallbearer

Pallbearer First Name:

Pallbearer Last Name:

Pallbearer

Pallbearer First Name:

Pallbearer Last Name:

Additional Pallbearers Required?

Yes

No

Pallbearer

Pallbearer First Name:

Pallbearer Last Name:

Pallbearer

Pallbearer First Name:

Pallbearer Last Name:

Pallbearer

Pallbearer First Name:

Pallbearer Last Name:

Pallbearer

Pallbearer First Name:

Pallbearer Last Name:

Pallbearer

Pallbearer First Name:

Pallbearer Last Name:

Pallbearer

Pallbearer First Name:

Pallbearer Last Name:

Purchaser Information

Purchaser Information Required?

Yes

No

Same as Informant

Purchaser First Name:

Purchaser Middle Name:

Purchaser Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Email:

Address 1:

Address 2:

City

Country

State/Province

Zip/Postal code

Phone:

Purchaser Social Security Number:

Additional Purchaser Required?

Yes

No

Purchaser First Name:

Purchaser Middle Name:

Purchaser Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Email:

Address 1:

Address 2:

City

Country

State/Province

Zip/Postal code

Phone:

Purchaser Social Security Number:

Additional Purchaser Required?

Yes

No

Purchaser First Name:

Purchaser Middle Name:

Purchaser Last Name:

Relationship:

FatherStep-FatherFather-in-LawGrandfatherMotherStep-MotherMother-in-LawGrandmotherSonStep-SonSon-in-LawGrandsonDaughterStep-DaughterDaughter-in-LawGrandDaughterBrotherStep-BrotherBrother-in-LawHusbandWifeSpouseSisterStep-SisterSister-in-LawUncleAuntNephewNieceCousinBoyfriendGirlfriendOther (please specify)

 

Email:

Address 1:

Address 2:

City

Country

State/Province

Zip/Postal code

Phone:

Purchaser Social Security Number:

Professional Services

Professional Services:

 Basic Arrangements ($2,750.00)

Embalming:

 Embalming ($695.00)

 Embalming after Autopsy ($755.00)

If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. you do not have to pay for embalming you do not approve if you selected arrangements such as direct cremation or immediate burial. If we charge for embalming we will explain why below.

Reason for Embalming:

Preparation of Remains:

 Topical Disinfection ($195.00)

 Custodial Care (per day) ($25.00)

 Dressing / Casketing ($170.00)

 Cosmetology ($100.00)

 Restoration (per hour) ($70.00)

 Hairdressing ($60.00)

 Removal of Medical Devices ($50.00)

Direct Burial:

 Direct Burial with Container ($3,825.00)

 Direct Burial without Container ($3,650.00)

Direct Cremation:

 Direct Cremation with Container ($2,840.00)

 Direct Cremation without Container ($2,800.00)

Forwarding and Receiving Remains:

 Forwarding Remains ($1,990.00)

 Receiving Remains ($1,990.00)

Other Services

Use of Staff and Related Facilities

Supervision Services

Other Staff

Use of Facilities

Other Facilities

Transportation

Transfer of Remains to Funeral Home

Vehicle Selection

Other Vehicles

Additional Mileage

Other Mileage

Merchandise

Casket Selection

Other Casket

Vault Selection

Other Vault

Urn Selection

Other Urn

Stationery

Stationery Options

 

Click the link below to view our stationery themes

Please Click Here To View Stationery Themes

Theme Selection:

Short Prayer:

Additional Merchandise and Services

Additional Services and Merchandise

Cremation Keepsakes

Other Merchandise

Cash Disbursement

Cash Disbursements:

Explanation of Charges

Explanation 1:

Explanation 2:

Explanation 3: