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For Immediate Assistance, Call 801-682-4391

OBITUARIES
ABOUT US
SERVICES
PLANNING AHEAD
GRIEF SUPPORT
RESOURCES
STORE
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Newcomer Form

Start Planning Form

Type of Arrangement

Select Type of Arrangement Needed*

Type of Arrangement

Loved one has passed (Immediate Need)

Pre-Plan for the future (Keep my Information on File)

Pre-Fund for the future (Open a Revocable or Irrevocable Trust)

Service Types

Service Types*

Service Types

Simple Cremation

Simple Cremation with a Graveside Service

Simple Cremation with a Final Goodbye

Anatomical Gift

Date of Death*

Place of Death (Facility or Residential Address)*

Legal Information of Decedent*

Legal Information (of Decedent)

Decedent First Name*

Decedent Middle Name*

Decedent Last Name*

Decedent Name Suffix

Sex*

Male

Female

Date of Birth*

Age

City of Birth*

State / Province / Region of Birth*

Country of Birth*

Veteran Heading

Veteran Information

Did your loved one ever serve in the armed forces?*

Yes

No

What Branch of Service?

Army (Air Corp)

Marine Corps

Navy

Coast Guard

Air Force

Other

If other please specify below

Origin Heading

Hispanic Origin / Race / Education / Marital Status

Hispanic Origin (Check the box that applies)

No, Not Spanish/Hispanic/Latino

Yes, Cuban

Yes, Puerto Rican

Yes, Mexican, Mexican American

Other

Race (Check the box that best describes your race)

White/Caucasian

Asian

Black or African American

Other

If other please specify below

Education (Check the box that best describes the highest degree or level of school completed)*

8th grade

9th-12th grade, no diploma

High school graduate or GED

Some college credit, but no degree

Associate’s degree

Bachelor’s degree

Master’s degree

Doctorate or Professional degree

Marital Status*

Never Married

Married

Widowed

Divorced

Separated

Surviving Spouse (If wife, First and Last maiden name)

Free Text

Occupation

Most Recent Occupation (Do not enter retired)*

Place of Employment (Last or longest)

Type of Business or Industry

City of Employer

State of Employer

Free Text

Current Address/Residence (of Decedent)*

Name of Facility of current address (If not facility, give address)*

Street Address of current address*

City of current address*

State of current address*

Zip Code of current address*

Free Text

Parents

Free Text

Father

Father's First Name

Father's Last Name

Free Text

Mother

Mother's First Name

Mother's Last (Maiden) Name

Free Text

Informant/Next of Kin

(Surviving spouse or person in charge of arrangements)

Next of Kin's First Name*

Next of Kin's Last Name*

Next of Kin's Relationship to Deceased*

Next of Kin's Street Address*

Next of Kin's City*

Next of Kin's State*

Next of Kin's Zip Code*

Next of Kin's Email*

Next of Kin's Phone*

Free Text

Additional Comments or Questions

Enter Comments or Questions

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We will get back to you as soon as possible.

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Appointment Request

Name*

Email*

Phone*

Preferred location*

Beavercreek Chapel

North Dayton Chapel

Kettering Chapel

Centerville Chapel

Message

Yes, please send me periodic updates from Newcomer.

We will treat your information with the utmost confidentiality and not share or distribute it in any way.

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