Basic Vitals - Callaway-Jones Funeral & Cremation Centers

Required Basic Vital Statistic Information

This information is required to begin the documentation and death certificate process. Please enter all or as many fields as possible. You may skip over if you don’t know something and call/email us with that information later. We cannot start the documentation process without ALL of this information.

Deceased Full Legal Name
First Middle Last Maiden (if female)
Most Recent Address of Deceased
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Ethnicity
Marital Status
- Married
- Widowed
- Divorced
- Never Married
Date of Birth
City & State of Birth
Father's Name
First Last
Mother's Name
First Last Maiden
Usual Occupation
Social Security Number
Branch of Military if Veteran
Surviving Spouse Name
First Middle Last
Informant or Next of Kin
This is the name and address that will appear on the death certificate of the person responsible for arrangements.
First Middle Last
Address of Next of Kin / Informant
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email Address
Cell Phone
Number of Death Certificates Requested
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Name
This field is for validation purposes and should be left unchanged.