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Immediate Arrangements

We are very sorry for your loss and stand ready to assist you in your time of need. If you have not already scheduled a meeting with us, please call us.

If you prefer, you are welcome to send us information using the form below. We understand that you may not have access to all of the details below (or would prefer to provide in person). You are welcome to fill out as much or as little as you prefer. We will cover the remainder when we meet with you.

At Need Form

Information about the deceased

Last Name

First Name

Middle Name

Maiden Name

Sex

Father's Name: First

Father's Name: Middle

Father's Name: Last

Mother's Name: First

Mother's Name: Middle

Mother's Name: Last

Mother's Maiden Name

Race

African-AmericanCaucasianNative AmericanHispanicAsian

Country of origin

Date of Birth

City of birth

State

OR Country if not USA

Date of Death

City of Death

State of Death

County of death

Location of death

Name of the place of death

Location (if other)

Social Security Number

Education

Primary

College

Usual occupation (most of life)

Type of business

Company (optional)

Marital status

If wife, enter maiden name

Surviving spouse address

Street

City

State/Province

ZIP/Postcode

Mother's full name

Father's full name

Type of disposition

Disposition will be

If cremation, disposition of ashes

Preparation and viewing

Viewing/embalming preference

I authorize Heavenly Gates Funeral Home to embalm

Name of authorizing person

Relationship to deceased

Veteran information

Was the decendent ever in the US Armed Forces?

YesNo

If no, continue to the next section

Branch of service

Date enlisted

Date discharged

Honorable discharge

YesNo

Service/Serial number

Copy of discharge papers is available

YesNo

Informant information

Name of person in charge

Relationship to deceased

Street

City

State/Province

ZIP/Postcode

Home Telephone

Cell phone

Email Address

Funeral/memorial service information

Preferred place of service

Religious denomination

Is there pre-need funeral insurance on decedent?

YesNo

If yes, specify type

Memorials & donation preferencesPlease list memorials or charitable donations that you'd like listed in the obituary

Special instructionsOptionally use the area below to provide additional information or instructions to us.

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We are available 24/7, 365 days a year.

If you need our services immediately, please call us.
We will begin the process of bringing your loved one into our care right away.

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