Providing Freedom to Celebrate Life.

Is this a pre-need arrangement? What's This?
Or has a death occured?
Deceased Info
Last Name
First and Middle Name
Social Insurance Number
SexM: F:
Date of Birth
Place of Birth
Date of Death
Age at time of death
Marital StatusSingle: Married: Widowed:
Divorced: Common-law: Same-sex Partner:
Name of Spouse / Partner
Industry
Work
Deceased Residence
Father Name and Place of Birth
Mother Name and Place of Birth
Pacemaker? Has it been Removed? Yes: No:
Informant Info
Name
Relationship to Deceased
Address
Telephone Number
Contact Email Address
Are you the Executor?Yes: No:
Have the near Relatives and the Executer, if any,
of the deceased been informed of the proposed cremation?		Yes: No:
Has any concerned person expressed
any objection to the preposed cremation?		Yes: No: