Brown-Van Hemert Funeral Homes - Addison, Hudson and Onsted Michigan

The following information is needed so we can prepare all of the necessary paperwork. Please be as specific as you can. If you need assistance or have any questions, please feel free to contact the funeral home at any time. Thank you.


Last Name:
First Name:
Middle Name:
Sex:
Race:
Date of Birth:	/ /
Place of Birth:	City State OR Country
Date of Death:	/ /
City of Death:
State of Death:
County of Death:
Location of Death:	If other, please indicate address:
Name of the Place of Death:
Social Security #:
Education
Usual Occupation: (most of life)
Kind of Business:
Company: (optional)
Marital Status:
Surviving Spouse:
If wife, provide maiden name:
Residence: (street Address)
City/Town:
Inside City Limits:
County:
State:
Zip Code:
Length of Residence in County:
Fathers Full Name:
Mothers Full Maiden Name:

Disposition will be:

If Cremation, disposition of ashes?:

Name of Cemetery (if applicable):

City:
State:

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.
The family preference regarding viewing/embalming is:

I authorize Brown- Van Hemert Funeral Homes to embalm:

Name of authorizing person:
Relationship to deceased:


Was Decendent ever in the US Armed Forces?:
YES NO (if no, continue to next section)
Branch of Service:
Date Enlisted:	/ /
Date Discharged:	/ /
Honorable Discharge:	YES NO
Military Serial #:
Is copy of discharge papers available?
YES NO (if yes, please bring for us to copy.)


Name of person in charge:
Relationship to deceased
Address:
City
State	Zip
Phone #:
Email:


Preferred Place of Service:
Religious Denomination (optional):
Is there Pre-Need Funeral Insurance or monies deposited in trust on behalf of the decedent?:	YES NO
If yes, specify type:


Note: Use box below to indicate any additional information that may be helpful at this time. Other details regarding services, merchandise, flowers, financing, etc., will be discussed and finalized at the arrangement conference. PLEASE CALL FOR AN APPOINTMENT. Thank you for completing our online arrangement form.