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Immediate Need

If a Death Has Just Occurred

Immediate Need Form

Your Name*

Your Email*

Your Phone Number*

Your Street Address*

City*

State/Province*

ZIP/Postcode*

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Personal Information of Deceased

Full Legal Name of the Deceased

Date of Birth*

State Of Birth

City of Birth

Social Security Number

Street Address of Deceased

City

State/Province

Zip/Postcode

Is the Decedent's address within city limits?

Yes

Unknown

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Family of the Decedent

Father's Full Legal Name

Mother's Full Legal Name & Maiden Last

Decedent's Marital Status

Surviving Spouse

Decedent's Sex

Decedent's Race/Ethnicity

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Education and Occupation History

Highest Level of Education Completed

Decedent's Usual Occupation

Type of Business/Industry

Did the Decedent serve in the military?

Yes

Was the Decedent ever a Peace Officer in this State?

Yes

If yes, which branch of service?

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Next of Kin Information

Legal Next-of-Kin or Agent of Decedent

Legal Next-of-Kin or Agent's Relationship to the Decedent

Legal Next-of-Kin or Agent's Phone Number

Street

City

State/Province

ZIP/Postcode

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Extra Questions

How many death certificates will you require?

How did you hear about us?

Visit www.prepaidfunerals.texas.gov for information relating to the purchase of pre-need funeral contracts including descriptions of the trust and insurance funding options available under state law.

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Immediate Need

If a Death Has Just Occurred

Immediate Need Form