Cremation Society of Rhode Island
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Data & File Form
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Serving Rhode Island Since 1993
Available 24 Hours a Day

 

 

 

Required Date & File Form

Please complete this form if you are making arrangements for a deceased loved one.

Proposed Client (Decedent)

Name

     (first)            (middle)         (last)            (suffix)

Sex

 Male     Female

Telephone


(include area code)

Street

City or Town

State

   Zip

Race

Place of Birth


(city & state or foreign country)

Marital Status

 Married    Never Married    Widowed    Divorced

Last Spouse


(if wife, give first and maiden name)

Usual Occupation


(prior, if retired)

Kind of Business or Industry

If U.S. War Veteran, specify war

Father's Name


(full name)

Father's State of Birth


(if not in U.S.A., name country)

Mother's Name


(first and maiden name)

Mother's State of Birth


(if not in U.S.A., name country)

 

 

 

RESPONSIBLE SURVIVOR

Title

 Mr.     Mrs.     Ms.

First Name

      Last Name

Street

City or Town

State

     Zip

Telephone

Relationship

 

 

 

FOR VETERANS USE ONLY

Date of Entering Military Service

Place

Date of Discharge


(Fax photocopy of Discharge Certificate)

Place

Rank, Rating

Organization, Outfit

Service Number

 

 

 

ADDITIONAL INFORMATION

List other survivors and/or obituary information:

 

 

 

Please click on the button below to submit this form.

 

Cremation Society of Rhode Island 571 W. Greenville Rd. - PO Box 216 No. Scituate, RI 02857
401-647-0620 1-800-941-2211
Serving the Entire State of Rhode Island 24 Hours A Day

© Copyright 2000-2017 Cremation Society of Rhode Island. All rights reserved.
Affiliated with Winfield & Sons Funeral Home, J. Winfield, Jr., FD/RE.
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