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The Serenity Mortuary, LLC
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740 North Gum Street,
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Summerville
,
SC
29483
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Tel:
1-843-225-7800
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Fax:
1-843-900-8548
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1-843-225-7800
CONTACT US
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“The Preferred Funeral Firm"
Celebrating 10 Years Of Service - Established May 1st 2013
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Push button for menu
Push button for menu
Home
Obituaries
About Us
About Us
Meet Our President
Our Staff
Why Choose Us
Contact Us
Testimonials
Privacy Policy
Where To Start
Gallery
Directions
Services
Our Services
Affordable Funeral & Cremation Services
Payment Center
A Touch of Serenity
Veterans
Veterans Overview
Veterans Headstones
Veterans Burial Flags
Resources
Making Arrangements
When Death Occurs
Grief Support
Funeral Etiquette
Social Security Benefits
Frequent Questions
Forms
Online Forms
Funeral Program
Newspaper Obituary
Vital Statistics Form
Vital Statistics Form
Vital Statistics Form
Information about the deceased
Last Name
First Name
Middle Name
Maiden Name
Sex
Male
Female
Father's First Name
Father's Middle Name
Father's Last Name
Mother's First Name
Mother's Middle Name
Mother's Last Name
Mother's Maiden Name
Race
African-American
Caucasian
Native American
HispanicAsian
Country of Origin
Date of Birth
City of Birth
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
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
OR Country if not USA
Date of Death
City of Death
State of Death
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
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
County of Death
Location of Death
Home
Emergency Room
Hospital
Nursing Home
In Transport
Others
Name of the Place of Death
Location (If Other)
Social Security Number
Education
Primary
0
1
2
3
4
5
6
7
8
9
10
11
12
College
Some College No Degree
Professional Trade School
Associate Degree
Masters Degree
Bachelors Degree
Doctorate Degree
Usual Occupation (Most of Life)
Type of Business
Company (Optional)
Marital Status
Married
Never Married
Divorced
Widowed
Surviving Spouse
If Wife, Enter Maiden Name
Surviving spouse address (Or legal next of Kin)
Street
City
State/Province
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland and Labrador
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
ZIP/Postcode
Mother's Full Name
Father's Full Name
Type of Disposition
Disposition will be
Earth Burial
Mausoleum Entombment
Cremation
Ship Out of Area
Not Sure
If cremation, disposition of ashes
Cemetery Burial or niche wall
Scatter
Take Home
Other
Not Sure
Preparation and viewing
Viewing/Embalming Preference
Viewing/Visitation
One-time viewing for immediate family
Use option required by disposition
No viewing/embalming
Not sure
I authorize Congo Funeral Home and Cremation Services to embalm
Yes
No
Will Advise
Name of Authorizing Person
Relationship to Deceased
Veteran information
Was the descendent ever in the US Armed Forces?
Yes
No
If no, continue to the next section
Branch of Service
Date Enlisted
Date Discharged
Service/Serial Number
Honorable Discharge
Yes
No
Copy of discharge papers is available
Yes
No
Informant information
Name of Person in Charge
Relationship to Deceased
Street
City
State/Province
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland and Labrador
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
ZIP/Postcode
Home Telephone
Cell Phone
Email Address
Funeral/Memorial Service Information
Preferred Place of Service
Funeral Home
Church
Other Will Advise
Religious Denomination
Is there pre-need funeral insurance on decedent?
Yes
No
If yes, specify type
Memorials & Donation Preferences
Please list memorials or charitable donations that you'd like listed in the obituary
Special Instructions
Optionally use the area below to provide additional information or instructions to us.
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