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Forms
Online Arrangement Form (after death has occurred)
Online Pre-Need Form (prior to a death occuring)
Cremation Authorization Form, Printable
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Comparison
Online Arrangement Form (after death has occurred)
Please complete this form and we will contact you within 2 business days. If you have questions prior to our contacting you please call
717-273-6283
and mention that you are completing At-Need Arrangements online.
Information Required to File a Death Certificate
Please complete the fields below. This information is only used for filing a death certificate and is kept in strict confidence.
Person Making Arrangements (Contact Person)
Note: the person making arrangements will be listed as the "informant" on the Death Certificate. The "informant” is simply the person providing the decedent's personal information. Normally this person is the "next of kin" such as: son, daughter, spouse, or other relative; or executor or attorney for estate.
First Name
Middle Name
Last Name
Contact Person Mailing Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email Address:
Phone Number of Contact Person
Relationship to Deceased
Deceased Person's Information
Legal forms require this information. If you do not know the answer to any of the below questions please enter the word "Unknown" in the appropriate field. Please note: The word "Unknown" will appear on the certified death certificate.
First Name
Middle Name
Last Name
Decedent's Social Security Number
Decedent's Date of Death
Date Format: MM slash DD slash YYYY
Decedent's Place of Death
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Boro or Twp Where Death Occured
County Where Death Occured
Decedent's Residence (Where they lived most of the time)
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Decedent's Boro or Twp of Residence
Decedent's County of Residence
Decedent's Date of Birth
Date Format: MM slash DD slash YYYY
Decedent's Age
Decedent's Birthplace
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Was the Decedent a U.S. Citizen
Yes
No
Sex of Decedent
Male
Female
Decedent's Race
Caucasian
African American
Hispanic
Asian
Other
Decedent's Marital Status
Married
Never Married
Widowed
Divorced
Name of Decedent's Spouse (include maiden name, if wife)
Check if Decedent's Spouse is Deceased
Was the Decedent In the Armed Forces?
Yes
No
Not Sure
Deceased individual's discharge papers (DD-214) will be required to receive military death benefits. Please mail us a copy or scan and email to info@LancasterCremations.com (please do NOT send originals)
Decedent's Usual Occupation
While many individual's have had many different occupations, please choose the one that would best represent the decedent.
Decedent's Kind of Business/Industry
i.e. manufacturing, retail, medical, laborer, etc
Decedent's Education (highest completed) Elementary & Primary (0-12)
1
2
3
4
5
6
7
8
9
10
11
12
Decedent's Higher Education
None
Some College Credit
Associates Degree
Bachelors Degree
Masters Degree
Doctorate/Professional Degree
Note: Higher education does NOT include technical, trade, or business schools.
Does the Decedent Have a Pacemaker?
Yes
No
Not Sure
Father's Name
First
Middle
Last
Legal forms require this information. If you do not know the answer to any of the below questions please enter the word "Unknown" in the appropriate field.
check if decedent's father is deceased
Mother's Name
First
Middle
Last
Mother's Maiden (last) Name
Legal forms require this information. If you do not know the answer to any of the below questions please enter the word "Unknown" in the appropriate field..
check if decedent's mother is deceased
Please Check One of the Following Options
Ship Cremated Remains ($125 fee)
Hold Cremated Remains for Pick-up
Where the remains should be shipped to?
Decedent's Children (oldest to youngest with spouse info and phone number and email address)
If children are deceased, please type "deceased" before the respective name.
First (Spouse) Last. Phone number, email address
Example: Mike (Sally) Jones. (717) 555-5555, MJones@gmail.com
Additional Notes
Additional Notes (optional)
please provide us with any other information that you feel is pertinent.