If not prepaying for services, we would hold this information on file along with any supporting documents. There is no membership fee involved for this.
Prepayment generally isn’t for when there is hospice care, as it involves setting of a policy as an irrevocable trust (funeral/cremation providers are not allowed to hold money directly). Setting up the policy in this way protects the money in the case of the medicaid spend down situation, and the money is still available if using another funeral/cremation provider. We guarantee the current prices for our services when prepaying.
If prepaying for services, after completing this form, we will contact you to coordinate completing a couple paperwork portions and then payment is made by check to the insurance company – United Heritage.
Middle names are optional for parents.
The social security number is needed if prepaying (for setting up the policy) and will be needed for filing the death certificate, however we will gather this sensitive piece of information later by other means.
Cemetery - This is optional for cremation.
Statistical Information - The following is information that does not show up on the death certificate, but is gathered by the government for statistical purposes.