Application Form

Separate REQUEST FOR FUNERAL ARRANGEMENTS forms must be filled out for each individual. If additional forms are needed, please contact us to request more. Please note that the questions on the form are taken from those on a death certificate. Whatever information you can give is helpful to the funeral director. Please do not fill in "retired" for your occupation.

Please choose a funeral director from the list of participating directors on the Funeral Directors page. Fill out both copies of the form. Keep one for your records and send the other back to the Cleveland Memorial Society.

Click here for a printable form

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