On-line At Need Form

Thanks for taking the time to fill out our Immediate Need Form. By completing the following information at your own convenience, you should find it easier to provide correct information and have some time to think about the type of services you desire.

The information provided on this form will help Hall-Wynne Funeral Service & Crematory complete the death certificate and other required documents. In addition, this information will assist the funeral director to better understand your initial wishes. Relaying required statistical information can be time consuming. Our desire is to help expedite the final arrangement conference at the funeral home and make the process a little more comfortable.

Please complete (as much as possible) the information on the form and select Submit Information at the end to send the information to us. You may also print out the form and bring it with you to the arrangement conference or fax.

If you'd prefer, a printer-friendly version of this form is also available for you to download and fill out manually. CLICK HERE for further instructions and the download link, if interested.

If you have any questions whatsoever, please contact Hall-Wynne Funeral Service & Crematory at: (919) 688-6387



NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

Deceased Vital Statistics for Death Certificate

* First Name:
* Last Name:
Middle Name:
Sex:
Race:
Date of Birth:
Place of Birth: City:

State:

Country:
Date of Death:
City of Death:
State of Death:
County of Death:
Location of Death:

If other, please indicate address:
Name of the Place of Death:
Education
Usual Occupation (most of life):
Kind of Business:
Company:
Marital Status:
Full Name of Surviving Spouse:
If Wife, Provide Maiden Name:
Residence - Street Address:
City/Town:
Inside City Limits:
County:
State:
Zip Code:
Length of Residence In County:
Father's Full Name:
Mother's Full Maiden Name:

Type of Disposition

Disposition Will Be:
If Cremation, Indicate Preference For Disposition of Ashes?:
Name of Cemetery (if applicable):
City:
State:

Preparation and Viewing

Important Note: Viewing of the body is a choice of the family. In most cases, embalming is required or recommended for public viewing/visitation, mausoleum entombment, or transfer of remains via common carrier (i.e. shipment by air or rail). When possible, the funeral home needs authorization from the next of kin for embalming.

The Family Preference Regarding Viewing/Embalming Is:
I Authorize Hall-Wynne Funeral Service & Crematory To Embalm:
Name of Authorizing Person:
Relationship To Deceased:

Veteran Information

Was Decedent Ever In the US Armed Forces?: Yes No (if no, continue to next section)
Branch of Service:
Date Enlisted:
Date Discharged:
Honorable Discharge: Yes No
Military Serial Number:
Is A Copy of Discharge Papers Available? Yes No (if yes, please bring for us to copy):

Informant/Person In Charge Information

* First Name:
* Last Name:
Relationship To Deceased:
* Email Address:
Address:
City:
State:
Zip Code:
Telephone Number:

Funeral/Memorial Service Information

Preferred Place of Service:
Religious Denomination:
Is there Immediate Need Funeral Insurance on decedent?: Yes No
If Yes, Specify Insurance Type:
(i.e., Forethought, Purple Cross, trust, etc.)

Other Information & Instructions

Please list any other instruction or information you would like us to have:





Immediate Need Form - Printer-friendly Version

You can download the printer-friendly version of the Immediate Need Form to your local computer from the link below. Once downloaded, open the PDF *, and enter your information on the form, then print it out on your printer. You may then either mail or fax it to us at the address or fax number below, or bring it with you when you visit.

»   CLICK HERE to download the form - choose to, 'Save to Disk,' in the dialog box that appears (download times will vary depending upon connection.)

Get Adobe Acrobat Reader* NOTE: Adobe Acrobat Reader software is required to view this file - if you don't already have the Reader installed on your computer, it is available for free from Adobe's website - please click the icon at right to be taken to the download page.

Mail or fax completed forms to the Hall-Wynne office of your choice.


 

 

Hall-Wynne Funeral Service & Crematory
1113 W. Main St.
Durham, NC 27701-2028
919-688-6387
Fax: 919-683-9539
Hall-Wynne - Griffin Chapel
396 West Street
Pittsboro, NC 27312
919-542-3057
Fax: 919-542-1468
Hall-Wynne - Franklinton Chapel
504 East Mason St.
Franklinton, NC 27525
919-494-2313
Fax: 919-494-1115
Gentry-Newell & Vaughan Funeral Home
503 College St. •  P.O. Box 57
Oxford, NC 27565
919-693-5191
Fax: 919-693-8999

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