Forms

What to do at time of death

What to do when somebody dies and you are acting as the funeral director:

If death is unexpected:
Basically this process is the same as if the death was expected, except that a medical examiner must be notified. Call 911 or your local law enforcement agency. If an autopsy is required, tell the coroner that you are acting as the funeral director, and to call you when the body is released.

Hospice, hospital, nursing home or at home expected to die:
Make sure everybody understands that the decedent wants a green burial, and has designated someone to handle the burial (act as a funeral director). Make sure everyone involved understands this. Once they understand that, they’ll help you do what is required.Call decedent’s doctor’s office. If the cause of death is from natural causes, get the name of the person contacted at the physician’s office who provided assurance that the physician would complete and sign the medical certification of death on the certificate and the date he/she was contacted. When speaking with the physician or staff in his/her office there are three questions that should be asked. 1.) Will the physician sign the death certificate? 2.) Will the physician be available to sign the medical certification within 72 hours after presented by the acting funeral director? 3.) Is there any reason this death should be reported to the medical examiner for investigation?The Bureau of Vital Statistics in the county of death will issue a death certificate and a burial-transit permit. You’ll need to know the following for the bureau’s registrar, who will help you fill out the death certificate. (The record must be typewritten in black ink. Instructions on how to complete the forms are included on the form itself.)

For an abbreviated but complete, one-page, printable copy click here

  1. Decedent’s name (First, Middle, Last)
    2.  Sex of decedent
    3.  Date of birth (Month, Day, Year)
    4.  Age
    5.  Date of Death (Month, Day, Year)
    6.  Social security number
    7.  Birthplace (City and State, or Foreign Country)
    8.  County of death
    9.  Place of death
    10. City, town, or location of death
    11. Marital Status
    12. Surviving spouse (If wife, given maiden name)
    13. Residence of decedent
    14.  Residence–state, county, city, town, or location; street address
    15. Occupation and industry of decedent
    16. Decedent’s race (Specify the race/races to indicate what the decedent considered himself/herself to be. More than one race can be specified)
    17. Decedent’s education
    18. Was decedent ever in the U. S. Armed Forces?
    19. Father’s and mother’s names (First, Middle, Last)
    20. Informant’s name, address, and relationship to the decedent
    21. Place of disposition (name of cemetery, or other place) and location of
    place of final disposition.

Final Burial Wishes:

CLICK HERE TO DOWNLOAD PDF OF FINAL BURIAL WISHES

By signing this form, I indicate my sincere desire to be buried in the Glendale Memorial Nature Preserve (GMNP). I have informed myself about natural burial and conservation burial and I understand and agree with GMNP’s burial policies attached (also stated at http://www.glendalenaturepreserve.org/).

I have discussed, or will discuss, these wishes with my spouse or life partner, my loved ones, my estate executor, and the person responsible for disposition of my body (family member or funeral director). This statement supersedes and replaces any prior statements I have made about the location and manner of disposition of my bodily remains after death. I understand that these wishes are for burial only; I will inform my loved ones of my funeral and/or memorial wishes.

Full legal name__________________________________________________________

Residence address_______________________________________________________

City/State/Zip__________________________________________________________

Home telephone_________________________________________________________

Mobile telephone________________________________________________________

Email address___________________________________________________________

Date of birth [MM/DD/YYYY] _____________________________________________

Place of birth ___________________________________________________________

Name and contact information for the person responsible for disposition of my body

Personal Information (PLEASE PRINT)

Signature______________________________________________________________

Witness Signature_______________________________________________________

Witness Name (Printed) ___________________________________________________

Date_________________________________________________________________

Date_________________________________________________________________

Please complete and return the signed form. Keep a copy for yourself and share copies with your loved ones and with the person responsible for disposition of your body.

Glendale Memorial Nature Preserve – A non-profit corporation
297 Railroad Avenue
DeFuniak Springs, FL 32433
Telephone: (850) 859 2141