RJ Slater IV Funeral Home & Cremation Service

Pre-Arrange Online

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Person in Charge of Final Arrangements (Legal Next of Kin):*

Relationship to the Deceased:*

Email: *

Telephone: *

Type of Service:

Death Certificates ($20 each)*

Street Address:

City:

State:

Zip Code:

Additional Instructions:

Full Name:

Gender:

Residence Address:

City:

State:

Zip Code:

Date of Birth:

Place of Birth:

Social Security Number:

Marital Status:

Surviving Spouse (Maiden Name):

Father's Name:

Mother's First Name

Mother's Maiden Name

Mother's Last Name

Additional Family Members:

Occupation:

Business Field:

U.S. Armed Forces Member:

Yes

Are you a spouse of a Veteran

Branch of Service:

Serial Number:

Do you have a copy of your discharge papers?

Yes