NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

Deceased Vital Statistics for Death Certificate

Sex

Place of Death

Education

Marital Status

Residence

Inside City Limits


Type of Disposition


Preparation and Viewing

Important Note: Viewing of the body is a choice of the family. In most cases, embalming is required or recommended for public viewing/visitation, mausoleum entombment, or transfer of remains via common carrier (i.e. shipment by air or rail). When possible, the funeral home needs authorization from the next of kin for embalming.

Except in certain cases, embalming is not required by law. Embalming may be necessary, however, if you select certain funeral arrangements, such as a funeral with viewing. If you do not want embalming, you usually have the right to choose an arrangement, which does not require you to pay for it, such as a direct cremation, immediate burial and/or one-time ID viewing for family only. If you elect NOT to order embalming, State law requires refrigeration of an unembalmed body that is held for over 24 hours from the time of death.

I Authorize Brandywine Valley Funeral Care To Embalm


Veteran Information

Was Decedent Ever In the US Armed Forces?

Honorable Discharge

Is A Copy of Discharge Papers Available? (If yes, please provide a copy)


Informant/Person In Charge Information

Address


Funeral/Memorial Service Information

Is there Pre-Need Funeral Insurance on decedent?


Other Information & Instructions