Deceased Information Deceased full Name * First Name Last Name Gender * Male Female Usual residence prior to death * Occupation Place of birth Date of birth MM DD YYYY Date of death MM DD YYYY Place of death Did the deceased identify as Aboriginal or Torres Strait Islander? Yes No Father's full name Mother's full name Mother's maiden name Spouse's full name (if applicable) Date of marriage MM DD YYYY Place of marriage Spouse's date of birth MM DD YYYY Spouse's date of death (if applicable) MM DD YYYY Children's full names and dates of birth Was the deceased on a pension? If so, what kind? Doctor's name Religion Cremation or burial Cremation Burial Clothing request for burial/cremation Cemetery (if applicable) Own reserve? Yes No Reserve portion? Section? Lot? Next of Kin Address of next of kin Address 1 Address 2 City State/Province Zip/Postal Code Country Phone for next of kin (###) ### #### Thank you!
