Online Arrangement Form (after death has occurred)

Address: 2024 Marietta Avenue, Lancaster, PA, 17603, US
Telephone: (717) 273-6283

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 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
Decedent's Place of Death
Street Address City 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 State ZIP Code
Decedent's Boro or Twp of Residence
Decedent's County of Residence
Decedent's Date of Birth
Decedent's Age
Decedent's Birthplace: (City)
Decedent's Birthplace: (State)
Decedent's Birthplace: (County)
Decedent's Birthplace: (Country)
Was the Decedent a U.S. Citizen
- Yes
- No
Sex of Decedent
Decedent's Race
Decedent's Marital Status
Name of Decedent's Spouse (include maiden name, if wife)
- Check if Decedent's Spouse is Deceased
Was the Decedent In the Armed Forces?
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)
Decedent's Higher Education
Note: Higher education does NOT include technical, trade, or business schools.
Does the Decedent Have a Pacemaker?
- Yes
- No
- Not Sure
Father's First Name
Father's Middle Name
Father's 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 father is deceased
Mother's First Name
Mother's Middle Name
Mother's Last Name
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 ($95 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.

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Accepted Payment Methods

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Satisfaction Guarantee

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Online Arrangement Form (after death has occurred)

Information Required to File a Death Certificate

Person Making Arrangements (Contact Person)

Deceased Person's Information

Decedent's Children (oldest to youngest with spouse info and phone number and email address)

Additional Notes

No Hidden Fee Guarantee

Accepted Payment Methods

Satisfaction Guarantee