Gladewater TX Funeral Home and Cremation Service

A Death Has Occurred

Use this form to provide us with as much or as little detail as you wish.  At a minimum, provide us with your name and telephone number and tell us how you'd like us to work with you on the remaining information using the options at the base of the form.

Pre-Arrangement Details

Vital Statistic Information Needed To Complete The Death Certificate

Please complete the form below with the true and correct information pertaining to the deceased so that we can complete and file a death certificate. Please bare in mind that knowingly providing false information for a death certificate is a crime and is punishable by a fine up to $10,000.00. If you are unsure of the information please indicate that in the blank.

Decedents Residence Address

Place of Death Address

Informant's Information (Person Providing Answers To This Form)

Military Record

Funeral Service Request

Disposition Request

(if applicable)
(if applicable)
(if applicable)

Summary Details

© 2024 East Texas Funeral Home. All Rights Reserved. Funeral Home website by CFS & TA | Terms of Use | Privacy Policy | Accessibility