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2. 
4. Today's Date*
   Today's Date
5. Time
   Time
7. Name of Funeral Home
9. Point of Contact*
10. Phone*
12. Name of Deceased
14. Last Name*
15. First Name and Middle Initial*
17. Other Names Known By
18. Maiden Name
20. Date of Birth*
    Date of Birth
21. Date of Death*
    Date of Death
22. Age
23. Gender*

    1. Male
    2. Female
25. Place of Birth*
26. Place of Death*
28. Veteran?*

    1. Yes
    2. No
29. If Yes, did they serve in any conflicts/wars?*

    1. Yes
    2. No
30. Military Salute?*

    1. Yes
    2. No
32. Relationship Status*

    1. Single
    2. Married
    3. Divorced
    4. Widowed
33. Name of Spouse
35. Address
37. City
38. State
39. Zip Code
41. Mother of Deceased
43. Last Name*
44. First Name*
45. Maiden Name
47. Father of Deceased
49. Last Name*
50. First Name*
52. Next of Kin
54. Last Name*
55. First Name*
56. Relationship*
58. Address*
60. City*
61. State*
62. Zip Code*
63. Phone
65. Last Name
66. First Name
67. Relationship
69. Address
71. City
72. State
73. Zip Code
74. Phone
76. Last Name
77. First Name
79. Address
81. City
82. State
83. Zip Code
84. Phone
86. Notice:

    Please provide the Township  two business days to complete preparations for burial.

88. Date of Funeral*
    Date of Funeral
89. Time of Funeral*
    Time of Funeral
90. Arrival Time at Cemetery*
    Arrival Time at Cemetery
92. Cemetery Section

    1. One
    2. Two
93. Cemetery Lot #
94. Grave #
96. Burial Type*

    1. Casket
    2. Cremains
97. Casket Type*

    1. Standard
    2. Urn
    3. Oversized
98. Length

    If Oversized

99. Width

    If Oversized

101. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
103. Electronic Signature*
104. Date*
     Date
106. Payment of Fees

     Fees may be paid via check, credit card, or E-Check (if paying by credit card, a convenience fee will be added to the total. If paying by E-Check, a flat rate of $1.75 will be added to the total).

108. Traditional Open and Close Fees

     Monday through Friday before 3:00 p.m.

     $750.00 Residents and Non-Residents

     $500.00 Infants (0-12 months)

     $500.00 Cremations

109. Price
     Total Due
110. Fee*
     -- Select One --Resident & Non-Resident - $750.00Infants (0-12 months) - $500.00Cremations - $500.00None - 0
111. Quantity
113. Taxable
114. Shipping Cost
118. Non-Traditional Open and Close Fees

     After 3 p.m. on weekdays or on Saturday (no Sundays)

     $1,300.00 Residents and Non-Residents

     $700.00 Infants (0-12 months)

     $700.00 Cremations

119. Price
     Total Due
120. Fee
     -- Select One --Residents and Non-Residents - $1300.00Infants (0-12 months) - $700.00Cremations - $700.00None - 0.00
121. Quantity
123. Shipping Cost
124. Taxable
128. Disinterment

     $2,250.00 Disinterment Casket

     $1,000.00 Disinterment Cremains

129. Price
     Total Due
130. Fee
     -- Select One --Disinterment Casket - $2250.00Disinterment Cremains - $1000.00None - 0.00
131. Quantity
133. Shipping Cost
134. Taxable
138. Other Fees

     $0.60 Footers per square inch

     $50.00 Transfer of lot

     $50.00 Preparation of deed

139. Price
     Total Due
140. Fee
     -- Select One --Footers per square inch - $0.60Transfer a lot - $50.00Preparation of Deed - $50.00None - 0.00
141. Quantity
143. Document Upload

     Please attach the death certificate and any other information we need.

145. Shipping Cost
146. Taxable
Leave This Blank:


149. Calculate Totals Proceed to Checkout

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