Online Submission Form

Personal Info

Name	First	Middle	Last (with Jr., III, etc.)
Gender
Age		Date of Birth
Place of Birth
Marital Status		Most recent spouse (if wife, give maiden name)	Living Deceased

Work Background

Was Decedent ever in U.S. Armed Forces?
NOTICE: We cannot provide any military benefits without the militaries discharge papers (DD214)

Decedent's Usual Occupation
(give kind of work done during most of working life. DO NOT USE RETIRED)

Kind of Business/Industry

Education and Ancestry

Decedent's Education (specify number of years completed)	Grade School	Secondary Education
Ancestry (ex. French, English, Irish, German, etc.)		Race (American Indian, Black, White, etc.)

Deceased or Prearranged Beneficiary Residence Information

Physical Street Address		City/Town
County		State
Deceased Parents Names
Father	First Name	Middle Name	Last Name
Mother	First Name	Middle Name	Maiden Surname
Informant or Contact Person
Name		Telephone Number	( )-
Mailing Address		E-mail

What type of service are you arranging for?

If you are finished, please press the submit button.
If you need further assistance or have questions please call (207) 945-4788.
Thank you for your trust in our abilities and services to service you in this time of need!

Memorial Alternatives

Online Submission Form