Funeral  & Cremation Services Beyond Your Expectations

Vital Statistics Information 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 Divine Mortuary Services 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.


If you have any questions whatsoever, please contact
Divine Mortuary Services at 770-322-8000
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Vital Statistics Information Form
###-##-####
Month, Date, Year
( U= Unknown)
( U= Unknown)
( U= Unknown)

( U= Unknown) ( D= Disabled)
( U= Unknown) (N= None)
( U= Unknown) (N= None)
First, Middle Name or Middle Initial, Last ( If Wife, Give Maiden Name) ( N=None)
First, Middle Name or Middle Initial, Last ( N=None)
First, Middle Name or Middle Initial, Last Name should be Maiden Name ( N=None)

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