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			Submission Date	Funeral Home	Submitted By	Status	First	Last	Customer First	Customer Last Name	Burial Type	DOD	DOI

New Case Submission
Contact information
First Name*
Middle Name
Last Name*
Address*
Address 2
City*
State*
Zip*
Phone*
Email
Deceased Information
First Name*
Middle Name
Last Name*
Maiden Name
Date of Birth
MM slash DD slash YYYY
Date of Death
MM slash DD slash YYYY
Date of Interment
MM slash DD slash YYYY
Age
Last Residence
City
State
Zip Code
Gender
Occupation
Mothers Name
Fathers Name
Place of Birth
Place of Death
Cause of Death
The following information concerning the cremation process is provided by CemSites Demo.
This service is subject to the following terms and conditions:
- The body presented to CemSites Demo is that of the deceased.
- All prosthetics (surgical pins/plates/ joint replacement etc.) will be discarded after the cremation process.
- For sanitation purposes, it is the policy of CemSites Demo that the body of the deceased be enclosed in a container.
- CemSites Demo is not responsible for any loss or delay of cremains by the U.S. Postal Service or other transportation service other than our own.
Special Instructions / Notes