Vital Information

From this page you can submit information for our records. This does not commit you to use our services or form any type of contract with us. This is used strictly as a convenience for you. You may also fill in this form and print it out for your records without sending it to us. This form requests the information that will help a Funeral Director complete the Michigan Death Certificate.

Which funeral home would you like to have keep this record?

Please identify and describe yourself:

First name

Middle name

Last name

Date of birth MM/DD/YYYY

Sex Male Female

Please provide the following contact and background information:

Street address

Address

City

State/Province

Zip/Postal code

Country

Home Phone

E-mail

Maiden Name

Social Security Number

Usual Occupation

Kind of Business or Industry

County of Residence

Township of Residence

Inside City or Village of

Birth Place

Marital Status

Spouse's Name

Were you ever in the Military

Branch of Military

Date of Entry to Military

Date of Discharge from Military

Can you locate your discharge?

What is your ancestry

What race are you

How much education have you completed

Father's Name

Mothers Full Name (Maiden Name)

Would you like us to call you?

When is the best time to call?

Please type this word as it is shown into this text box

Don't forget to fill out the Services page, the obituary information page and the Survivors page.