At-Need Information Form

Field's with a * are required. If you do not know the answer enter the word "Unknown". If the field requires a number and you are unsure enter all Nines (9). Example SS#: 999-99-9999. At the time of need you will need to have the unknown information for the Death Certificate process.
  • Contact Person

  • Social Security Number will need to be provided at time of arrangements
  • --

  • Deceased Person Information

  • (If retired occupation prior to)
  • Father

  • Legal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.
  • Mother

  • Legal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.
  • Legal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.
  • Cemetery Information

  • Church Information

  • Family Information

  • Children (oldest to youngest with spouse info)

  • Grandchildren (oldest to youngest with spouse info)

  • Great Grandchildren (oldest to youngest with spouse info)

  • Siblings (oldest to youngest with spouse info)

    If siblings are deceased, please type "deceased" before the respected name.
  • Memorials

  • Past Services Held at Hitzeman Funeral Home

  • Membership in Organizations, Clubs or Societies

  • Use separate line for each entry.
  • People / Groups to Notify about Funeral Services

  • Use separate line for each entry.
  • What is the Name and contact information (*Address, Phone and Fax if applicable*) of your loved one's Primary Care Physician?