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OBITUARY NOTIFICATIONS

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ABOUT US
OBITUARIES
SERVICES
PLAN AHEAD
RESOURCES
ONLINE FORMS
CONTACT US

Deceased Information

When Death Occurs

If you do not wish to submit your information online, please download and print our information form. Complete the form and return to our offices at:

Southern Nevada Mortuary

GET DIRECTIONS

Information about the deceased

Deceased Information Form

Last Name

First Name

Middle Name

Maiden Name

Sex

Fathers Name

Fathers Name

First Name

Middle Name

Last Name

Mothers Name

Mothers Name

First Name

Middle Name

Last Name

Free Text

Race

New Field:

African-American

Caucasian

American Indian or Alaskan Native

Hispanic or Latino

Asian

Native Hawaiian or Other Pacific Islander

Country of Origin

Date of Birth

City of Birth

State

OR Country if not USA

City of Death

State of Death

County of Death

Location of Death

Location (if other is selected)

Name of the Place of Death

Social Security Number

Primary Education

College Education

Usual occupation (most of life)

Type of business

Company (optional)

Marital status

Surviving Spouse

If wife, enter maiden name

Surviving spouse address

Surviving Spouse Address

Street

City

State/Province

ZIP/Postcode

Mother's Full Name

Father's Full Name

Type of disposition

Type of Disposition

Disposition will be

If Cremation, Disposition of Ashes

Free Text

Preparation and Viewing

Viewing/embalming preference

I authorize Southern Nevada Mortuary to embalm

Name of authorizing person

Relationship to deceased

Free Text

Veteran Information

Was the decendent ever in the US Armed Forces?

Yes

No

If no, continue to the next section

Branch of Service

Date Enlisted

Date Discharged

Honorable discharge

Yes

No

Service/Serial Number

Copy of Discharge Papers Is Available

Yes

No

Free Text

Informant Information

Name of Person In Charge

Relationship to Deceased

Address

New Field:

State/Province

ZIP/Postcode

Home Telephone

Cell Phone

Email Address

Free Text

Funeral/Memorial Service Information

Preferred Place of Service

Religious Denomination

Is there pre-Need Funeral Insurance on Decedent?

Yes

No

If Yes, Specify Type

Free Text

Memorials & Donation Preferences

Please list memorials or charitable donations that you'd like listed in the obituary

Free Text

Special Instructions

Optionally use the area below to provide additional information or instructions to us.

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