Obituaries/Tributes
& Condolences
Advanced Planning
Resources
Contact Us
About Us
Member of
Utah & National
Funeral Directors Association Utah Funeral Directors Association
Utah Funeral Directors Association
 

Planning and Death Certificate Information

The following information is required for submssion of the death certificate and will also be used for preparation of the service program and newspaper obituary. This information will be treated very confidentially and will not be used in any way except for carrying out the family wishes for funeral services. You may elect to:

  1. fill out the form, print it and mail, fax or bring it in to the office
  2. fill out the form and save it in our secure database for future editing - we then can acces the data directly as required. You will be issued an account name and password so you may access and edit the nformation as desired.
  3. print a blank form, fill it out and mail, fax or bring it in to the office
  4. bring the information into the office for us to fill out the form
Individual Information
Name
Date of Death Time of Death
Place of Death
Doctor
Residence
Age Birthday
Place of Birth
Race Marital
Status
Hispanic Type
Social
Security #
Degree of
Education
Occupation
Industry
Father's
Name
Mother's
Name
Informant Information
Name
Address
Relationship
Home Phone Cell Phone

Funeral Service Information
Clergy
Place of
Service
Interment
Clothing
Hair
Vets Rites By

Marriage Information
Spouse
Maiden Name
Place of
Marriage
Date of
Marriage 		Date of
Spouse's
Death

Previous
Spouses'

Military Information
Branch of
Service		 War Served
In
Date Of
Entry		 Date of
Discharge
Rank Service
Number

Interests
Hobbies
Church
Activities
Clubs

Family Information
Children - Name, City & State Living
Brothers & Sisters & Where Living
Number of
Grandchildren		 Number of
Great-Grandchildren
Grand Parents
Preceeded In
Death By
Number of Death Certificates Wanted
(First one $13.00, each additional $8.00)

           

 
In Memorium In Memorium
Search Archives
A B C D E G H J L M N P R S T W

William Caffee
b: 1/8/1921
d: 11/15/2008
Service: 11/19/2008, 11:00 am
Green River Ward

George Huckins
b: 6/8/1927
d: 11/8/2008
Service: 11/16/2008,7:00 pm
Moab Arts and Recreation Center


 © 2007 Spanish Valley Mortuary