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Home
About
Cremation
- Cremation Packages
- Urns
Funeral
- Funeral Packages
- Caskets
Obituaries
Forms
Plan Ahead
Contact

Fisher Funeral Home & Cremation Service

24501 Five Mile Road Redford Township, MI 48239

(313) 535-3030

Call (313) 535-3030

Vital Statistics Form

Please fill out this form and contact Fisher Funeral Home directly. Put “Unknown” for any fields you do not know.

Deceased Vital Statistics for Death Certificate

Please fill out this section about the deceased.

First Name*

Middle Name*

Last Name*

Date of Birth

Sex

Date of Death

Name at birth or other name used for personal business (include AKA's if any)

Birth Place

Birth City

Birth State

Location of Death

Location

Address of Location

Method of Disposition
BurialCremationEntombmentDonation

Current Residence

Please fill out this section about the deceased.

Deceased's Street Address*

City*

State*

Zip*

Personal Information

Race

Ancestry

Hispanic Origin:
YesNo

Social Security Number

Highest Education*

U.S Military Veteran:
YesNo

Do You Have a Copy of the Discharge Papers?
YesNo

Please indicate job title(s)

Please indicate what industry they worked in

Marital Status*

Name of Surviving Spouse

Father's Name

Mother's Name

Mother's Maiden Name*

Contact Person

Please fill out this section about the person signing the form.

Your First Name*

Your Last Name*

Your Phone Number*

Your Email*

Your Relationship to the Deceased*

Your Home Address
Street Address*

City*

State*

Zip*

Please select an option

Fisher Funeral Home
& Cremation Service

24501 Five Mile Road
Redford Township, MI 48239
(313) 535-3030

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