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Home
OBITUARIES
ABOUT
SERVICES
PLAN AHEAD
CONTACT
Cremation Center
RESOURCES
Plan a Funeral
- Merchandise
- Wilbert Vault Videos

GET IN TOUCH

help in grief

Forms

Download/View Documents

Death Certificate Information

Decedent's Legal Name:

Gender:

Age - Last Birthday (Years)

Free Text

Under 1 Year

Months

Days

Free Text

Under 1 Day

Hours

Minutes

Date of Birth

Birthplace

Free Text

Residence

State

County

City or Town

Street and Number

Apt. No.

ZIP Code

Inside City Limits?

Yes

Ever in Armed Forces?

Yes

Marital Status at Time of Death

Married

Married, but Separated

Widowed

Divorced

Never Married

Unknown

Surviving Spouse's Name Prior to First Marriage

Mother/Parent Name Prior to First Marriage

Father/Parent Name Prior to First Marriage

Informant's Legal Name

Relationship to Decedent

Mailing Address

Method of Disposition

Burial

Cremation

Donation

Entombment

Removal from State

Other

If Other, Specify

Place of Disposition

Location

Decedent's Education - Check the box that best describes the highest degree or level of school completed at time of death

8th Grade or less

9th-12th grade, no diploma

High school graduate or GED completed

Some college credit but no degree

Associate degree (e.g. AA or AS)

Bachelor's degree (e.g. BA, AB, BS)

Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA)

Docrtorate (e.g., PhD, Edu) or Professional Degree (e.g. MD, DDS, DVM, LLB, JD)

Decedent of Hispanic Origin?

No, not Hispanic or Latino

Yes, Mexican, Mexican American, Chicano/Chicana

Yes, Puerto Rican

Yes, other Spanish/Hispanic/Latino/Latina

If other, specify

Decedent's Race - Check one or more boxes to indicate what the decedent considered themself to be

White

Black or African American

American Indian or Alaska Native

Asian Indian

Chinese

Fillipino

Japanese

Korean

Viatamese

Other Asian

Native Hawaiian

Guatemalan or Chamorro

Samoan

Other Pacific Islander

Other

If Other, specify

Decedent's Usual Occupation (Indicate type of work done during most of working life. DO NOT USE THE TERM "RETIRED")

Kind of Business/Industry

Free Text

The above was reviewed and found to be correct. I attest that all information is accurate and truthful. I understand that it is a felony to willfully or intentionally supply false information.

Digital Signature

Date

Thank you for submitting the Death Certificate Information form.

We will get back to you as soon as possible, if applicable.

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Memorial Guide

Free Text

Contact church and minister about time, place and date of service. Get approval from Sullivan Bros. Mortuary for

date and time; due to changing seasons (daylight savings time) and cemetery guidelines. Weekend fees and after

hour fees may apply.

Free Text

Vital information required at conference:

Free Text

Deceased Information

Name (Full)

Address:

City/State:

ZIP:

Free Text

Please provide proof of Social Sec. Num.

Date of Birth:

Age:

Place of Birth:

Spouse Name:

New Field:

Living

Deceased

Years of Marriage:

Education Background:

Last known occupation (Company name):

Church membership:

Fraternity/Sorority Associations:

Hobbies:

Free Text

Person responsible for making funeral arrangements: (Mailing Address)

Name:

Address:

City/State:

ZIP:

Phone Number:

Cell Phone Number

Email:

Free Text

Deceased: Parents' Information

Name of Mother: (Include maiden)

New Field:

Living

Deceased

Name of Father:

New Field:

Living

Deceased

Free Text

VA Information: A copy of his/her military DD-214 must be Honorable Discharge **Veteran Services

available thru M.J. Dolly Veteran Cemetery located in Anderson, SC and other National Veteran Cemeteries**

Newspaper Notice: please select

(Greenville News)

(Spartanburg H-J)

Other

Free Text

Clothing Items: Please bring these items for the arrangement conference

For a female-dress, skirt, stocldngs, uocler-gannents, slip, blouse or top if necessal'y, earrings, necklace. Makeup brought in for use will not be returned due to restrictions.
For a male-Suit, shirt, tie, pants, socks, under-garments.

Free Text

Disclaimer: Sullivan Bros. Mortuary will not be responsible for any jewehy or anything of value that the family or friends place with their loved one. Flowers purchased by family and friends should be delivered to Sullivan Bros.

Mortuary during business hours 9:00am-:00pm (M-F and weekends by phone call delivery) Deliveries will not be

accepted after that or 2 hours prior to service.

ALL CHANGES TO SERVICE MUST COME FROM BUYER!

Free Text

Social Security Number: Please provide proof of this number, preferable social security card.

Free Text

Privacy Act: Due to Privacy Act Federal laws of 1974 and its amendments, Sullivan Bros. Mortuary Inc. staff do not give out a family phone number, address or any information concerning the family member in our care unless families sign a release giving Sullivan Bros. Mortuary Inc. the permission to do so, Because of the privacy act and in

respect to your family, please only invite those that are needed to complete the service arrangements. Unless told

to our Funeral Director, information provided will be used for public notifications (Website and/or Funeral Programs)

Thank you for submitting a Memorial Guide form.

We will get back to you as soon as possible, if applicable.

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