Name: Plan Online
Price: 1395 USD
Availability: InStock

Product Info

✔ Online arrangements.
✔ Professional basic services of the funeral directors and staff.
✔ Obtaining the cremation permit from the county in which the death occurred (Fees from the County Medical Examiner/Coroner are not included).
✔ Transfer of the deceased from the place of death to the funeral home.
✔ Our staff is available any time of the day or night.
✔ Submitting of Veteran Benefit Paperwork.
✔ Cremation at a licensed crematory.

What is the approximate weight of your loved one? *

Where is your loved one located? *

How would you like to receive the cremated remains? *

I would like assistance obtaining Certified Death Certificates. ($15 per copy) *

Middlesex Cremation offers the assistance to obtain a certified death certificate as an optional service. Families can obtain a certified death certificate directly from the county health department on their own. However, we are happy to obtain certified copies of the death certificate from the health department on your behalf and mail them to you.

Viewing *

Caskets / Alternative Containers

Please call us at (978) 622-1234 after the completion of the checkout process as a check and balance to ensure there were not any technology glitches in notifying us of your loved one's passing.

We extend our deepest sympathies to you for your loss.

There may be additional costs associated with the transportation of your loved one into our care. The cost, if applicable, is calculated based on the distance between the "Location of the deceased" and our facility. If the location of the deceased lies outside of the service area, the cost will be calculated in your cart. Please contact us with any additional questions.

Location of Deceased *

Location of your loved one for transportation into our care.

Information About the Person Completing This Form

First Name *

Last Name *

Phone Number *

E-mail *

Street Address *

City *

State *

Zip *

Person for whom I am filing for:

Deceased Vital Statistics for Death Certificate

If you don't have the information for a specific field, please leave it blank and we can collect it later.

Prefix

First Name *

Middle Name

Last Name *

Gender *

Race

Date of Birth *

MM - DD - YY

Date of Death *

MM - DD - YY

City of Birth

State of Birth

Social Security Number

Deceased's Street Address

Deceased's City

Deceased's State

Deceased's Zip

Education

Occupation (most of life)

Business/Industry

Deceased of Hispanic Origin?

How many living adult children the deceased has?

How many living adult siblings the deceased has?

Marital Status

Full Legal Name of Spouse

Prefix

First Name

Middle Name

Last Name

Maiden Name (If Applicable)

Father's Full Name

Prefix

First Name

Middle Name

Last Name

Father's birthplace State/Province

Mother's Full Name

Prefix

First Name

Middle Name

Last Name

Maiden Name (If Applicable)

Mother's birthplace State/Province

Veteran Information

If your family would like a flag provided by the federal government, please email a copy of an Honorable Discharge Form (DD-214) to michael@middlesexcremation.com

Was Deceased Ever In the US Armed Forces? *

Branch of Service *

Plan Online

Delivery

24/7 Support.

Online Payment.