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Weyauwega 920-867-3399

Manawa 920-596-2500

Weyauwega 920-867-3399

Manawa 920-596-2500

ABOUT US
OBITUARIES
SERVICES

PLANNING AHEAD
GRIEF SUPPORT
RESOURCES

IMMEDIATE NEED

If a Death Has Just Occurred

Immediate Need Form

Free Text

The information listed below is confidential and, when submitted, will only be shared with the funeral home.

Free Text

Name of Your Loved One

First:

Middle:

Last:

Maiden:

Address:

City:

State:

Zip:

Township or Village (please specify):

County:

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Other Demographic Information of Your Loved One

Sex:

M

F

Race/Ethnicity:

Tribal Member:

Y

N

Marital Status:

Married

Divorced

Widowed

Never Married

Birthplace:

Date of Birth:

Father's FULL Name:

Mother's FULL Name

Mother's MAIDEN (Birth Last) Name:

Usual Occupation (DO NOT LIST RETIRED or UNEMPLOYED):

Employed in What Type of Industry:

Social Security Number:

Highest Education:

Spouse's FULL Name:

Spous's MAIDEN Name (F):

Was Your Loved One a Veteran?:

Y

N

Branch:

Honorably Discharched?:

Y

N

Free Text

Informant (REQUIRED FOR DEATH CERTIFICATE):

Name:

Relationship to Deceased:

Address:

Phone:

Alternate Phone:

Number of Death Certificates You Would Like:

Free Text

What Was Your Loved One's Final Wishes?

What Was Your Loved One's Final Wishes?

Funeral Service With Earth Burial

Funeral Service Followed By Cremation

Natural Burial (Green)

Cremation With Memorial Service/Celebration of Life

Private Family Viewing Followed by Cremation and/or Earth Burial

Cremation With No Service

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Fax: 920-867-3398

Fax: 920-867-3398

SUPPORT AFTER A LOSS

Circle of Friends+ provides you with resources on grief support and settling affairs, sent to you via text and email.

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