Cremation Identification - 2 | Blue Star Cremation

Authorizing Agent

Please complete this section with information for the person filling out the form

Name*

First Last

Relationship to decedent

Email*

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name of Decedent*

Date of Birth of Decedent*

Date of Death*

Time of Death

: HH

MM

Age of Decedent*

Please enter a value between 0 and 150.

Place of Death*

Street Address Address Line 2 City State ZIP Code

Hospice

Medical Examiner’s Authorization Required

Death Due to an Infectious Disease

Comments

This field is for validation purposes and should be left unchanged.