Vital Statistics Form | Milwaukee Cremation

Information About the Person Completing This Form

Name*

Prefix First Middle Last Suffix

Phone*

Email Address*

Milwaukee Cremation is an entirely online service. We require your email address in order to send DocuSign paperwork. Your information will not be sold or shared with any external entities.

Person for whom I am filing for:*

If not "Myself", your relation to the deceased.

Please specify your relationship*

Your Address*

Street Address City State ZIP Code

Deceased Vital Statistics for Death Certificate

The following section is about the loved one that you are filing for. Please input their information where prompted.

Name of Deceased*

Prefix First Middle Last Suffix

Place of Death

Please enter where your loved one has originally passed

Other (please specify)

Please specify place of passing

Current Location of Decedent*

Location of your loved one for transportation into our care. If your loved one is already in our care, please put "Already in your care"

Date of Death

State of Birth

*If your loved one was not born in the US, please select the bottom option "Not born in the US"

City of Birth

Country of Birth

If your loved one was not born in the USA, please select their country of birth from the list if the country of origin is not listed, please select "Other"

Please Specify Unlisted Country Of Origin:

Date of Birth

Legal Gender

Marital Status at Time of Death

Name of Surviving Spouse

First Middle Last Suffix

Father's Full Name

First Middle Last Suffix

This is the name of the father of the decedent

Mother's Full Name

First Middle Last Suffix

This is the name of the mother of the decedent

Mother's Maiden Name

Maiden name of the mother of the decedent

Deceased's Legal Address

Same as my own (provided above)
Input new address

Deceased Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Residence Inside City Limits?

Yes
No

Education

Occupation (most of life)

Please note that this is for state statistical information and thus "retired" is not an acceptable input

Business/Industry of Occupation

Race

Deceased of Hispanic Origin?

No
Yes (Specify)

Specify Hispanic Origin

Veteran Information

Did the deceased ever serve in the US Armed Forces?*

Yes
No

Military Branch*

Additional Next of Kin Info

According to Wisconsin State Statute 154.30 Section 2, if multiple people under the same level of next of kin exist, a majority must agree on cremation before it can legally be performed. Power of Attorney can only sign on behalf of the surviving Next-of-Kin if that power is expressly given in the POA document. If the POA document does not expressly give permission to make arrangements on behalf of the person, then that POA document is null and void after death.

Are there multiple next of kin or is the legal next of kin someone other than yourself?*

Yes
No

Please List Any Additional Next of Kin

Please include names, phone numbers, and email addresses of any additional next of kin who will be signing the cremation authorization

Please list any other instruction or information you would like for us to have

Phone

This field is for validation purposes and should be left unchanged.