Vital Statistics Form

Decedent's Vital Information

First Name

Middle Name

Last Name

Suffix

Gender

Date of Birth

Social Security Number

Birthplace

Decedent's Residence

Street

City

State/Province

ZIP/Postcode

Is Residence Inside City Limits?

Marital Status

Spouse's Full Name

Spouse's Maiden Name

Optional Info

Is the decedent a military veteran?

Race

Highest Education

Main Occupation

Decedent's Parents

Father's Full Name

Mother's Full Name

Mother's Maiden Name

Person Making Arrangements

Full Name

Relationship to the Person Above

Email Address

Cell Phone

Telephone

Street

City

State/Province

ZIP/Postcode

If Known

Date of Death

Place of Death

How Many Death Certificates Do You Need?

Would you like us to create an Online Tribute Page on our website?

Cremation Decisions

Is there a pacemaker present?

After the cremation

Urn Selection

After the cremation, in what type of container would you like your loved one's cremated remains returned? (choose one)

Service / Ceremony

Will there be a ceremony before or after the cremation?

Final Resting Place:

Anti-Spam Security Question

Guardian Angel Funeral Home
| 2412 Little York Rd
| Houston, TX 77093
| Tel: 1-713-697-7378
|

Guardian Angel Funeral Home
| 2412 Little York Rd
| Houston, TX 77093
| Tel: 1-713-697-7378
| Fax: 8883802729

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