Removal & Transfer Request

Deceased Person's Information

Decedent Full Name

Decedent Date of Birth

Decedent Date of Death

Place of Death (Hospital, Home, etc)

Location of Body (address)

Approximate Weight of Deceased

Are there stairs the removal team should be aware of?

Yes

If yes, please describe:

Funeral Home Information

Funeral Home

Funeral Home Contact Name

Funeral Home Contact Phone Number

Transport Type

Removal

State-to-State Transfer

Other

If other, please specify:

Pickup Address

Delivery Address (Receiving Funeral Home/Facility)

Preferred Date For Removal

Preferred Time for Removal

Special Instructions

Contact Person For Arrangements

First Name

Last Name

Relationship to the Deceased

Phone *

Email *

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