Vitals - At-Need

  • Information

PLEASE NOTE

All information on this form is required to complete state and federal documents. In order for Direct Cremation Services of Virginia to better serve you, we ask that you please submit all infromation that is asked for.

The information in this step is about the deceased and is required to populate state and federal documents.

Vital Information

Address

Was Decedent Ever In US Armed Forces?

INSTRUCTIONS FOR ENTERING A DATE
Step 1: CLICK ON CALENDAR IMAGE THEN MONTH & YEAR
Step 2: SELECT MONTH, TYPE YEAR THEN CLICK OK
Step 3: SELECT DESIRED DATE

Was Decedent Ever Married, Separated, Divorced or Widowed?

This step asks for the decedent's birth information and is required to populate state and federal documents.

Birth Information

INSTRUCTIONS FOR ENTERING A DATE
Step 1: CLICK ON CALENDAR IMAGE THEN MONTH & YEAR
Step 2: SELECT MONTH, TYPE YEAR THEN CLICK OK
Step 3: SELECT DESIRED DATE

This step requires information on the death and is required to populate state and federal documents.

Death Information

INSTRUCTIONS FOR ENTERING A DATE
Step 1: CLICK ON CALENDAR IMAGE THEN MONTH & YEAR
Step 2: SELECT MONTH, TYPE YEAR THEN CLICK OK
Step 3: SELECT DESIRED DATE

In this step, please enter information for the decedent's parents. It is required to populate state and federal documents.

Parent Information
Deceased's Information

The contact is the person who is submitting the information. We require this to populate state and federal forms as well as for communication purposes.

Contact Information

Will You be Picking Up Remains?

The authorized individual is the person(s) who is authorized to pick up or receive the cremains. It could be you or it could be another family member or friend.

Additional Authorized Individuals?

The purchaser is the person(s) who is paying for the cremation merchandise and services. This information will be applied to a contract and sent to you for signature.

Purchaser Information
Other Information

Would you like your loved one's information presented in an interactive obituary page on our website? Please note, you are not required to make this decision now and can contact us at a later point.

If yes, you can upload a photo and obituary to add to the online listing. (Acceptable file formats: jpg, jpeg, png, doc, docx, rtf, txt)

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