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Arrange Cremation

*We will receive the information you submit during normal business hours. If you need urgent assistance, please call (303) 578-4111. If you wish to pre-arrange cremation, please contact our office during normal business hours for more information.

For those on Medicaid, SSI, or county assistance, help may be available. Please contact us at (303) 578-4111 for more information.

Basic Cremation

To be used for Death Certificate

Decedent's Information

First Name*:

(if none, leave blank)

Middle Name:

Last Name*:

Location of Deceased (if at our facility, leave blank)

Location of Deceased
(if at our facility, leave blank)

Address:

City:

Country:

State/Province:

Zip/Postal code:

Date of Death*:

Sex*:

Social Security Number:

Place of Birth*:

Date of Birth*:

Total Years of Education*:

County will not accept "retired" or "disabled".

Occupation*:

Kind of Business or Industry:

Was decedent in U.S. Armed Forces?*:

Yes

Marital Status*:

If married or widowed, please include spouse's full maiden name:

Decedent's Address

Decedent's residence address

Address*:

City*:

Country*:

State/Province*:

Zip/Postal code*:

Race*:

Hispanic Origin*:

If Yes to Hispanic Origin, please specify (Cuban, Spanish, etc.):

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:

Name of person providing this information*:

Relationship to Deceased*:

Informant's Address

Address*:

City*:

Country*:

State/Province*:

Zip/Postal code*:

Number of death certificates (county charges $20 for first certificate, $13 ea. additional)*:

Telephone Number*:

Email Address*:

Unless cremation was previously authorized by deceased, no cremation may take place without written authorization from the Deceased’s next of kin or legal representative*.

*If deceased pre-authorized, certain criteria must be met.

Authorizing the Cremation

Name of next of kin or legal representative*:

Relationship to deceased*:

Is decedent currently married?*:

Does the decedent have any children?

First and Last Name of Child 1:

First and Last Name of Child 2:

First and Last Name of Child 3:

First and Last Name of Child 4:

First and Last Name of Child 5:

Disposition of Ashes

Disposition of Ashes*:

Closing Questions:

What happens next? A representative from A Basic Cremation will contact you during regular business hours. If you need urgent after-hours assistance, please contact us.

Please wait

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Have Questions? Call Us!

Arrange Cremation

Get Started With Online Arrangements

Basic Cremation

Location of Deceased (if at our facility, leave blank)

Decedent's Address

Informant's Address

Does the decedent have any children?

My Selections

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Have Questions? Call Us!

Arrange Cremation

Get Started With Online Arrangements

Basic Cremation

Location of Deceased (if at our facility, leave blank)

Decedent's Address

Informant's Address

Does the decedent have any children?

My Selections

Less Discounts

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Phone Us: (303) 578-4111

Has a Death Occurred?
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