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Legal information for person whom arrangements are being made

First Name

Date of Death

Date of Birth

Social Security Number

Middle Name

County of Death

If less than one day use time

City or Town of Birth

Last Name

Gender

MaleFemale

Most Recent Birthday

State or Foreign Country of Birth

Address of person for whom arrangements are being made

Address Line 1

Address Line 2

Street

City

State/Province

ZIP/Postcode

Inside City Limits?

YesNoUnknown

Length of Time at this Residence

Other information

Education

OccupationDo not use retired

Kind of Business/Industry

U.S. Veteran

Race or Ethnicity

Marital Status

Surviving Spouse/Partner's NameIf wife, please use maiden name prior to first marriage

Parents' information

Father's First Name

Mother's First Name

Father's Middle Name

Mother's Middle Name

Father's Last Name

Mother's Last Name (maiden name)

Informant information

Informant Name

Relationship to Person Arranged For

Informant Address Line 1

Informant Address Line 2

Street

City

State/Province

ZIP/Postcode

Place of death

If Death Occurred in a Hospital

Death Occurred Elsewhere

Facility Name (if not facility give street addres

Street

City

State/Province

ZIP/Postcode

Certification

This information will be used to prepare legal documents. Gaffney Funeral Home will not be responsible for incorrect information. I attest the information above to be true and accurate. I understand changes and/or corrections after filing will be at my expense.

Electronic Signature

Today's Date

Anti-Spam Security Question

Contact Us

1002 S. Yakima Ave.
| Tacoma, WA 98405
| Tel: 253-572-6003
| Fax: 253-597-7347

1002 S. Yakima Ave.
| Tacoma, WA 98405
| Tel: 253-572-6003
| Fax: 253-597-7347
| Directions

Start Paperwork

In this section

Legal information for person whom arrangements are being made

Address of person for whom arrangements are being made

Other information

Parents' information

Informant information

Place of death

Certification

Contact Us

It is never too early to start planning for yours or your loved one's funeral.