Online Arrangement Form

Informant Person Completing Form
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Cell Phone
Work Phone
Relationship to Deceased*
Deceased Person Information
Name*
First Middle Last
Residence*
Street Address Address Line 2 City State ZIP Code
Gender*
Date of Death*
MM slash DD slash YYYY
Date of Birth*
MM slash DD slash YYYY
Birthplace: City, State, Country*
Social Security Number

The SSN is required to complete the arrangements. If you don't feel comfortable entering the information here, we will call you by telephone to retrieve the SSN.
Marital Status*
Name of Spouse (maiden name, if wife)
Veteran*
Name of War and Years*
Usual Occupation*
Kind of Business/Industry*
Highest Level of Education Achieved*
Parents
Legal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.
Father's Name*
First Middle Last
Father's Place of Birth*
Step-Father Name
Mother's Name*
First Middle Last Maiden
Mother's Place of Birth*
Step Mother Name
Cemetery Information
Burial/Cremation/Anatomical Study*
Cemetery Name
Location City/Location State of Cemetery
Church Information
Church Name
Denomination
Church Address
Street Address Address Line 2 City State ZIP Code
Church Phone
Clergy's Name
First Last
Clergy's Phone
Family Information
In each section below, please list first and last names, from oldest to youngest, including spouse names and noting "deceased if/where relevant.
Children
Grandchildren
Great Grandchildren
Siblings
Membership in Organizations, Clubs or Societies
Organizations, Clubs, Societies: Name & Contact Information
Use separate line for each entry.
People / Groups to Notify about Funeral Services
Name of Person / Group & Email Address
Use separate line for each entry.
Race/Ethnicity
Hispanic Origin
Was the decedent Spanish/Hispanic/Latina?
- No, not Spanish/Hispanic/Latina
- Yes, Mexican, Mexican American, Chicana
- Yes, Puerto Rican
- Yes, Cuban
- Yes, other Spanish/Hispanic/Latina (e.g. Spaniard, Salvadoran, Dominican, Columbian)(specify)
If not Spanish/Hispanic/Latina, check “No” box. If Spanish/Hispanic/Latina, check the appropriate box.
Other (Please Specify)
What was the Decedent’s Race?
(Please check one or more races to indicate what the decedent considered him/herself to be.)
- White
- Black or African American
- American Indian or Alaska Native (name of enrolled or principal tribe)
- Asian Indian
- Chinese
- Filipino
- Japanese
- Korean
- Vietnamese
- Other Asian (specify)
- Native Hawaiian
- Guamanian or Chamorro
- Samoan
- Other Pacific Islander (specify)
- Other (specify)
Other (Please Specify)

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Providence, Rhode Island

June 28, 2022, 2:00 am

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Informant Person Completing Form

Deceased Person Information

Parents

Cemetery Information

Church Information

Family Information

Membership in Organizations, Clubs or Societies

People / Groups to Notify about Funeral Services

Race/Ethnicity