Please select the type of general services you are looking for.

Only complete if Cremation was selected above for the type of services

(Please see our Pricing page for descriptions of our packages and other services - Removal Fee will be added to package price)

(Please select actual or expected county of Death. The Medical Examiner can elect to charge a fee to approve the cremation in each county, and most do. This is not a charge of the Cremation Facility & is not included in Cremation Package Prices)

(Please select how the cremated remains should be handled) *If Cremation was not selected as disposition, please choose the "N/A..." option below

(1 - Black Polymer Urn included in the Simple Cremation packages | 1 - Premium Brass/Alloy/Wood Urn, up to $195 value, included in the Premium Cremation packages) AVAILABLE URN OPTIONS CAN BE FOUND AT: WWW.OURURNCATALOG.COM

These questions pertain to any type of disposition, please respond as needed

*If Yes, Next of Kin must sign an authorization form before prints can be taken and must be received prior to cremation or prints will not be taken

(final price for urns & jewelry will depend on actual item selected)

(ie - number of prayer or acknowledgement cards needed, number of memorial folders needed, type of alternate or keepsake urn or jewelry you are looking for, etc.)

Please understand that the date requested may not be possible (depending on the current case load, weekends, holidays, issues with doctors signing, etc.) and if that is the case we will let you know but we will make our best effort to accommodate your wishes. **Cases are handled in the order they are received unless the family has requested to expedite the process and selected the appropriate option for this.

(Copies through us are $12/copy | SIMPLE CREMATION Packages - 1 copy included | PREMIUM CREMATION Packages - 6 copies included) *WHEN ENTERING # OF COPIES, PLEASE LIST THE TOTAL YOU WANT OF EACH TYPE (discounts for included copies will be shown on the Statement & you will only be charged for any number over what the package includes)

(SEE NOTATION FROM FL HEALTH DEPT. BELOW REGARDING WHO CAN RECEIVE)

PLEASE NOTE: The cause of death cannot be included when requesting copies for probate issues. The cause of death is not needed for real estate taxes, property claims, vehicles title transfer or closing out bank accounts Life insurance often requires the cause of death

In this section, please provide the information requested regarding the Deceased person. These are state mandated questions required to complete the death certificate. If any of the information is not known or cannot be acquired, please enter "Unknown".

**MUST BE THEIR CURRENT LEGAL NAME THAT MATCHES THE NAME ON THEIR SOCIAL SECURITY CARD TO PASS THE SYSTEM VERIFICATION WITH THE SOCIAL SECURITY ADMIN**

City and State or Foreign Country where the Deceased was born

(If Not USA, please change to appropriate country)

Must provide the current LEGAL marital status of the deceased at the time of death. If you are unsure, use "Unknown".

DO NOT USE "RETIRED" OR "DISABLED" (indicate type of work done during most of the working life, even if they only worked for 1 day) Disabled can only be used if the person was disabled their entire life from birth & never worked a single day Homemaker can be used for anyone that only worked within the home

Do not use a company name

(Please specify what Native Tribe, Other Asian, Other Pacific Islander, or Other if selected above.)

(Specify if decedent was of Hispanic or Haitian Origin)

(Specify the decedent's highest degree or level of school completed at time of death)

(if unknown type 'Unknown')

(please include maiden name if known)

Enter Last Name before first marriage. The State requires this information if known; if not known please type "Unknown"

If you answer "Yes", please complete the rest of this section regarding Date and Place of Death

(name of the person providing this information for the death certificate)

(specify if you are LEGALLY the spouse, son, daughter, mother, father, brother, sister, etc.)

(If "Other" was selected above, please specify your relationship to the deceased)

(If Not USA, please change to appropriate country)

(any documents that we provide for review or signature will be sent via email; please check your email regularly during this process)

Contacts that select to receive correspondence by text must opt in to receive messages from AM Cremation & Funeral Care by checking this box. By doing so, they agree to receive messages related to pricing inquiries, customer questions, and missing case information regarding disposition after death, death certificates, cremation, funeral, and customer support. Additionally, standard notifications about customer purchases or relationships with our business, as well as delivery status updates of our products/services, are sent. Message frequency varies, and message and data rates may apply. For assistance, text HELP or INFO, and to opt-out, text STOP or UNSUBSCRIBE. We confirm that no mobile opt-in information is shared with third parties. For more information, please visit our Privacy Policy at https://amcremations.com/privacy-policy and our Terms & Conditions at https://amcremations.com/terms-of-payment-and-refund-policy

(This info will only be used on the Statement of Goods & Services)

Per FL law the order of authority for Legal Next of Kin is: spouse, children, parents, siblings, grandchildren, grandparents, aunts/uncles, cousins, etc. & must be over the age of 18 to make decisions regarding disposition.

(Attending or other Doctor to sign the death certificate)

(Please provide any other additional info or instructions not covered above or state any questions you may have here.)

Service & Death Certificate Info Form

Please complete the service information & required demographic information for the Death Certificate below: