Arrangement Form - Complete Care Cremation

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We want to make this process as easy as possible for you. We are here for you every step of the way.

The purpose of this form is to collect vital statistic information for your Loved One’s death certificate. Please be accurate.

The State of Texas requires the Legal Next of Kin to make cremation arrangements. Complete Care Cremation, LLC requires all equal Legal Next of Kin to give consent.

My name, hereby referred to as "Main Contact", is:. (Required)

I am making arrangements for my "Loved One" whose name is: (Required)

The relation between the Main Contact and Loved One is: (Required)

Is the Main Contact the Legal Next of Kin? (Required)

Yes
No

If yes, the Main Contact's phone number is:

Email address is:

If no, the Legal Next of Kin is:

Phone number is:

Email address is:

Home address is: (Required)

Address Line 1

City

State

Zip / Postal Code

County

Is there more than one Legal Next of Kin? If yes, please provide all names, phone numbers and email addresses below.

The following information is needed for your Loved One.

Name of Loved One: (Required)

Loved One's Home Address: (Required)

Address Line 1

City

State

Zip / Postal Code

County

Maiden name (if applicable):

Date of Birth: (Required)

Race: (Required)

AKA (legal alias only if applicable):

Place of Birth:

SSN: (Required)

Loved One's Father (Required)

Loved One's Mother: (Required)

Loved One's Marital Status: (copy) (Required)

Maiden Name: (Required)

If married, Loved One's Spouse's Name:

If married, Loved One's Maiden Name:

Loved One's Highest Level of Education: (Required)

Loved One's Occupation: (Required)

Loved One's Military Service: (Required)

Loved One's Occupation Industry: (Required)

Number of Death Certificates to Order: (Required)

Does your Loved One have a battery operated device: (Required)

Yes
No

Does your Loved One have any communicable disease: (Required)

Yes
No

Location of Death: (Required)

Address of Loved One's location: (Required)

Address Line 1

City

State

Zip / Postal Code

County

For identification, Loved One's height: (Required)

Weight: (Required)

ID Marks: (Required)

Phone