Register for Cremation Contact Information Contact Name: Contact Email: Contact Phone: Personal Information Full Legal Name: Maiden Name (if applicable): Date of Birth: Sex: MaleFemale Social Security Number: Military Information Armed Forces: YesNo Branch of Armed Forces: Air ForceArmyCoast GuardMarinesNational GuardNavy Served in Combat? YesNo If yes, which countries? Location Information City and State of Birth: Complete Residential Address: City: State: AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--District of ColumbiaPuerto RicoGuamAmerican SamoaU.S. Virgin IslandsNorthern Mariana Islands ZIP: Residence County: Is this inside city limits? YesNoNot Sure Work and Education Information Usual Occupation before Retirement: Type of Industry: Highest Grade of Education: High School Grad/GEDSome CollegeAssociatesBachelorsMastersPhDOther Family Information Father's Full Name: Mother's Full Name: Maiden Name: Marital Status: MarriedWidowedDivorcedNever MarriedLegal SeparationReg. Domestic Partner Spouse's Full Name: Maiden Name: Other Information Race: Hispanic Origin? YesNo