The following form provides our staff with the necessary information to complete your funeral or memorial service arrangements and file the Certificate of Death with the State of Oregon.

Please be as accurate and complete as possible, as this information will be used on legal documents and corrections are difficult to make. If you have any questions please call us at 541-342-6853.

Decedent's Information:

Death Information

Decedent's Background

If you would like us to apply for veterans benefits we will need a photo copy of the discharge papers often know as a (DD214).

Spousal & Parental Information

Informant Information

Disposition Information

Additional Information

Preparation and Viewing

Important Note: Viewing of the body is a choice of the family. In many 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.

Funeral/Memorial Service Information