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The following information will be used for completion of all legal documents. Including, but not limited to, certified death certificates, cremation permits, social security notification and veteran claim forms. Required fields are marked with an "*".

Informant and Next of Kin Information

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Member Information

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Veteran?
* Marital Status





Member's Residence

Member's Background

Of Hispanic Origin?
Disposition
I hereby authorize DuPage Cremations, Ltd. & Memorial Chapel to use the above information to complete all legal documents. I further state that this information is true and correct.

The following is an electronic signature:

 
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Todays Date

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