Online Forms - Affordable Cremations CT

Please fill out this form after you speak with one of our staff members. This form will not serve as notification of passing.

First Name*

Middle Name

Last Name*

Age

Date of Birth*

Place of Birth

Date of Death*

Deceased's Address

Place of Death

Father's Name

Mother's Name

(use maiden name)

Veteran?

Highest Education Level

Social Security Number (use dashes)

Sex

Race (please choose from one of the following selections and specify if necessary)

Specify Race (If Applicable)

Marital Status

Spouse's Maiden Name (First & Last)

Citizen

Occupation (Before Retirement)

Employer (Before Retirement)

Number of Certified Copies of Death Certificate requested at $20.00 each:

Your Name*

Relationship to Deceased*

Your Address

Your Phone Number*

After submitting this form you will be contacted about the next steps in the process.

Necessary Forms