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
Identification Of The Decedent
Name of Decedent*
Date of Birth of Decedent*
MM slash DD slash YYYY
Date of Death*
MM slash DD slash YYYY
Time of Death

: Hours

Minutes

AM/PM
Age of Decedent*
Please enter a number from 0 to 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.

Cremation Identification – 2