Immediate Need Form

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YOUR INFORMATION

Your Name*

Your Mailing Address*

Your Email*

Your Phone*

Alternate Phone (cell, fax, etc.) - please label

Your Relationship to the Deceased*

Which Schrader Funeral Home location do you prefer?

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DECEASED'S INFORMATION FOR THE DEATH CERTIFICATE

Full Name of Deceased (first, middle, last)*

Home Address of Deceased (Street Address, City, State, ZIP)

Last 4 Digits of Social Security Number

Date of Death*

Place of Death*

Address of Place of Death (street address, city, state, ZIP)*

Date of Birth*

Place of Birth (City, State)*

Was Deceased of Hispanic Origin?

Race of Deceased

Marital Status*

Significant Other's Full Name (including Maiden, if applicable)

Father's Full Name (first, last)

Mother's Full Name (first, last, maiden)

Highest Level of Education Completed (years)

Occupaton (cannot use "retired")*

Kind of Business or Industry

Veteran of U.S. Military?*

Are the Veteran's Discharge Documents Immediately Available?

Are Military Burial Honors Requested? (Verification required)

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SERVICE PLANS AND DETAILS

Visitation or Viewing

Location of Visitation or Viewing

Visitation or Viewing Details/Instructions

Funeral or Memorial Ceremony*

Location of the Ceremony

Clergy or Officiant for Ceremony (name, church or contact info)

Music for the Ceremony

Music for Ceremony Details

Other Details/Instructions for Ceremony

Method of Disposition*

Location of Disposition (cemetery or crematory name & location)

Details/Instructions for Disposition

Will you require limousine(s) for family transportation?

Charity for Memorial Contributions

Obituary

St. Louis Post Dispatch (Paid)

St. Louis Post Dispatch (Paid with Photograph)

Out of Town Newspapers (Paid)

Schrader Website Only

No obituary

Use this space to list names and relationships for the obituary

Use this space to list any other important information

Payment options*

Immediate Need Form

Immediate Need Form

Schrader Funeral Home & Crematory

Schrader Funeral Home - Eureka