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Vital Statistics Form

Complete this form as much as possible. This is just a start and can be changed. If you have an urgent need, please contact us.

Complete This Form If a Death Just Occured

Your First Name

Your Last Name

Email:

Phone:

Free Text

Who's this plan for?

Deceased's Information

Deceased's Information

Deceased First Name

Deceased Last Name

Birth Date

Birth Place

Gender

Male

Female

Other

Free Text

Family Information

Marital Status:

Married

Single

Widowed

Father's Full Name

Mother's Full Name

Address - If Living

Disposition Preference

Have cemetery arrangements been made?

Siblings (Living)

Siblings (Deceased)

Children (Living)

Children (Deceased)

Grandchildren (Living)

Grandchildren (Deceased)

Great-Grandchildren (Living)

Great-Grandchildren (Deceased)

Free Text

Education & Work

Highest Level of Education

School Name

School Location

Occupation

New Field:

Years at Company

Free Text

Military Service

New Field:

Yes

Branch of Service

Years Served

Interested in Honors?

Yes

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Beaufort, SC

The Serenity Historic Beaufort Chapel

613 Carteret Street, Beaufort, South Carolina 29902, United States

Tel: (843) 998-2940

Fax: (843) 998-9414

Summerville, SC

The Serenity Summerville Chapel

740 North Gum Street, Summerville, South Carolina 29483, United States

Tel: (843) 225-7800

Fax: (843) 998-9414