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At-Need On-line Form

AT-NEED ONLINE FORM

 

Making funeral arrangements at the time of loss is extremely difficult for those left behind. Our deepest condolences and blessings to the family. Making funeral arrangements at the time of a loss is very difficult.

 

We here at Crowe's Funeral Home, Inc. understand the emotional and financial stress involved with making funeral arrangements. Such stress can cause confusion and may affect your decision making. Allow Us To Serve You!

 

We will like to introduce the At-Need Online Form where you can take your time with filling in all preliminary and vital information which is half of the funeral process.

 

Upon reviewing all the information, the funeral director will contact you to schedule an appointment to help establish the most elegant and affordable funeral service your loved one and the family deserves.

 

I. Deceased Information

 
Deceased Full Name:
Sex:
Age:
If under 1 year: month(s)    day(s)
If under 1 day: hour(s)   
Date of Birth: (month/date/year)
Date of Death: (month/date/year)
Social Security Number: (xxx-xx-xxxx)
Did deceased serve in U.S. Armed Services?
(If yes, please see Military Record)
 

 
Place of Death:
If Other, Specify
Name of Hospital or Nursing Home
Address 1:
Apt., Building, Suite, Room or Unit
City:
State:
Zip Code:
   
Hospice Care:
(If Yes, please fill in all below)
Doctor's Name:
Doctor's Address:1
Building, Room or Suite
City:
State:
Zip Code:
Phone Number: (xxx-xxx-xxxx)
   
Deceased Residence
Address 1:
Apt., Building, Suite or Unit
City Name:
State:
Zip Code:  
   
Marital Status:
Name of surviving spouse
(If wife, give maiden name)
   
City of Birth:
State of Birth:
Highest Education Level:
 
Decedent Father's Name
Decedent Mother's Name with maiden name
   
Last Known Occupation:
Kind of Business or Industry
   
   
II. Military Record
 
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):Please bring all documentation with you
Military Honors at Graveside:
Person designated to receive flag:
   
Surviving Spouse Full Name:
(If wife, please give maiden name)
Spouse Social Security Number:
Spouse Address 1:
Apt., Building, Suite or Unit Number
City:
State:
Zip Code:
   
   
III. Service Preferences
 
Type of Service:
Preferred Time of Day for Viewing:
 
Preferred Time of Day of Funeral:
 
   
Casket:
(Rental Caskets are for cremation services only, Metal caskets come with sealer or non-sealer)
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry: (List all jewelry provided)
Glasses:
Outer Container Preference: (for ground burial only, inquire at the funeral home)

 

 

IV. DISPOSITION
 
Cemetery or Crematory Name:
Location:
The cemetery property is in the name of:
Anyone interred or buried  in the grave:
(If Yes, Fill in all information below)
Individual interred or buried:
Date of Death:    
Section:
Grave Number:
Plot Number:
Lot:
Block:
 

 

 
V. INSURANCE INFORMATION
   
Insurance Company Name:
Phone Number: (xxx-xxx-xxxx)
Address 1:
Room, Suite, etc.
City:
State:
Zip Code:
   
Policy Number(s):
List all Beneficiary(s) & Relationship   
   
Policy Effective Date:    
   

VI. INFORMANT INFORMATION
 
Informant Name/Person Handling Arrangements:
Relationship:
If Other, Please Specify:
   
Address 1:

Apt., Building, Room, Unit or Suite:
City:
State:
Zip Code:
   
Home Number: (xxx-xxx-xxxx)
Cell Number: (xxx-xxx-xxxx)
E-mail Address:
   
   
   

Miscellaneous Notes and Instructions:


 

Yes, I agree that all the information given to the best of my knowledge is true and factual.
Sign:
Date:
 


     

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Book of Memories

The pinnacle of memorialization, any family member or friends can take advantage of this free services by creating an account and a book to memorialize their loved one.

Immediate Need

If you have immediate need of our services, we're available for you 24 hours a day.

Obituaries & Tributes

It is not always possible to pay respects in person, so we hope that this small token will help.

Pre-Arrangement

Dying is one of the few events in life that's certain to occur, yet one we rarely plan for. Should we spend more time preparing for a two week vacation than we do our last days on Earth?

Expressions of Sympathy

It can be difficult to find the right words, so we have hand-picked a collection of sympathy and remembrance gifts that will be cherished.

Order Flowers

Offer a gift of comfort and beauty to a family suffering from loss.

Daily Grief Support by Email

Grieving doesn't always end with the funeral: subscribe to our free daily grief support email program, designed to help you a little bit every day, by filling out the form below.

Weekly Email Tips to Support a Grieving Friend

It's hard to know what to say when someone experiences loss. Our free weekly newsletter provides insights, quotes and messages on how to help during the first year.

Proudly Serving the Communities of Jamaica, Jamaica Estates, South Ozone Park, Ozone Park, Brooklyn, Richmond Hill, St. Albans, Hollis, Springfield Gardens, Rosedale, Laurelton, Kew Gardens, Cambria Heights, Queens Village, Elmont, Hempstead, Uniondale, Freeport, Valley Stream, Manhattan, and Bronx
(718) 558-0921 Crowe's Funeral Homes, Inc. | 107-44 Sutphin Blvd | Jamaica, NY 11435 | Fax: (718) 558-0924 | Email: crowesfh@aol.com (718) 558-0921 Crowe's Funeral Homes, Inc. | 107-44 Sutphin Blvd | Jamaica, NY 11435 | Fax: (718) 558-0924 | Email: crowesfh@aol.com (718) 558-0921 Crowe's Funeral Homes, Inc. | 107-44 Sutphin Blvd | Jamaica, NY 11435 | Fax: (718) 558-0924 | Email: crowesfh@aol.com (718) 558-0921 Crowe's Funeral Homes, Inc. | 107-44 Sutphin Blvd | Jamaica, NY 11435 | Fax: (718) 558-0924 | Email: crowesfh@aol.com (718) 558-0921 Crowe's Funeral Homes, Inc. | Crowe's Funeral Homes, Inc. | 107-44 Sutphin Blvd | Jamaica, NY 11435 | Fax: (718) 558-0924 | Email: crowesfh@aol.com