Pre-Needs Online Form

What is funeral planning? It is making decisions about a funeral ahead of time. It involves: gathering information for the death certificate, choosing the ceremony or service, that meets your wishes, dealing with legal and financial issues in advance and making wise choices so you may have the kind of funeral that's best for you, your family and loved ones.

By completing this form, you are gathering vital statistical information that will be needed for the death certificate. By continuing on, you may select the type of services you wish and the casket selection. Following this review, you may elect to pre pay for the services you selected. Please call 503.364.2257 and we will visit with you how this may be accomplished or any other questions or concerns you may have.

Information needed for the Oregon Death Certificate is as follows:

First Name:
Middle Name:
Last Name:
Date Of Birth:	(Format: MM/DD/YYYY)
Birthplace City:
Birthplace State:
Highest Education Achieved:
Ever in the U.S. Armed Forces?	No Yes
Social Security Number:
Usual Occupation or Title:	(Please do not list "Retired")
Type of Industry:
Current Address:
City:
State:
Zip Code:
Within City Limits?	No Yes
Marital Status:	Single Married Widowed Divorced
Spouse's Name:	(If married or widowed, give name prior to first marriage.)
Father's Name:
Mother's Name:	(Name prior to first marriage.)

Contact Information

Name:
Phone:	(Format: 000-000-0000)
Email Address:

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