Immediate Need (Children)

We want to offer you our warmest sympathy for the passing of your precious child. Please complete this online form to provide our staff with information to begin the arrangement process, prepare necessary paperwork, and to file the Death Certificate. In accordance with Oklahoma Law, information must be provided in full in order for the Funeral Director to file the Death Certificate within 24 hours of the passing.

Once we received this completed form, our Funeral Director will walk you through the next steps. You may respond by text to the link received, or call our office at (405) 354-2533 with any questions.

Immediate Need Information for Children

Personal Information of Your Child

Full Legal Name (First, Middle, Last, Suffix)

Date of Birth/Delivery

Facility Name (if not a hospital, give specific address)

Place of Birth (City, State, Zip)

Gender

Date of Death

Gestational Weeks Completed (if Stillbirth)

SSN # (put N/A if card never received)

Education Level

Grade-School (8th grade or less)High-School with diploma or GEDHigh-School with no diplomaNot Classifiable

Parent Information (Must Match Names on Birth Certificate or Adoption Paperwork)

Additional Family Members: Siblings (separate with commas)Please use the area above to enter the names of siblings, if any. (Identify those who are deceased)

Additional Family Members (separate with commas)Please use the area above to enter the names or total number of any other type of family members. (Identify those who are deceased)

Funeral Or Cremation Preferences

Funeral Home Service Desired

Cremation Only

Cremation with Seeing Your Loved One

Cremation with Memorial Service

Funeral Service with Burial of casket

Graveside Service with Burial of casket

Place of Service

Place of Service Other - Please Specify

Place of Visitation

Final Disposition Preference

Cemetery

Next of Kin Information

Person (Legal Next of Kin) to be listed on Death Certificate

Relationship Type

Parent (Biological and/or Adopted)

Adult Sibling

Appointed Guardian

Other (Please specify)

**Next of Kin listed in order of Legality

Relationship Type - Specify DetailsList further information if necessary

Street

City

State/Province

ZIP/Postcode

Telephone

Email Address

Legal Next of Kin IDPlease Attach a Picture ID of Legal Next of Kin

Sleeping Angels Care Fund Assistance

Amount Family is Able to Put Toward Services from Personal Checking or Savings Accounts:

Additional instructions or requests for us

How did you hear about Ingram, Smith & Turner Mortuary?

Family served in the past by Ingram, Smith & Turner

Attended funeral/service at Ingram, Smith & Turner

Recommended by friend

Recommended by Nurse or Chaplain

Google/social media search

Other

By signing my name, I understand that if this information is not submitted as soon as possible, the progress of obtaining a certified death certificate will be delayed.

Ingram, Smith & Turner Mortuary
| 201 E. Main St
| Yukon, OK 73099
| Tel: 1-405-354-2533

Ingram, Smith & Turner Mortuary
| 201 E. Main St
| Yukon, OK 73099
| Tel: 1-405-354-2533
|

Phone: 1-405-354-2533