Collins Funeral Home » Online Form

FUNERAL PLANNING FOR:
Please complete the section below as much as possible. This information will be utilized to complete the certified death certificate, the newspaper notices, and the funeral plan.
Prefix
FIRST NAME
MIDDLE NAME
LAST NAME
Suffix
Photograph
Gender
Maiden Name
Religious Preference
Residence
Street Address City State ZIP Code
Social Security #
No dashes (ex: 123456789)
Marital Status
Date of Birth
MM
DD
YYYY
Place of Birth
(City, State or Foreign Country)
Father's Name (FIRST MIDDLE LAST)
Mother's MAIDEN Name (FIRST MIDDLE MAIDEN)
Race
Hispanic Origin
Citizenship
Occupation
Career for most of working life--not "Retired." Examples include homemaker, attorney, plumber, etc...
Industry
OTHER Industry (specify):
Highest Level of Education
Veteran of United States
Branch of Military
War Served
Other War/Era (specify):
Rank at Discharge
Upload Copy of Discharge (DD-214)
Copy of Discharge (DD-214) is required to secure burial flag, schedule burial at veteran's cemetery and/or any additional recognition by the applicable Military branch.
Date of Enlistment
MM
DD
YYYY
Place of Enlistment
Date of Discharge
MM
DD
YYYY
Place of Discharge

FUNERAL SERVICE PREFERENCES
Final Disposition
Cemetery
OTHER Cemetery (specify):
Name, Address, City/Town and State, Phone# and contact. You may also include information about the exact location of the grave (section, lot, site).
Grave Information
Section#, Lot#, Site#
Owners of Cemetery Property
This information is used to verify availability of grave sites
Location of Visitation/Wake
Desired time(s) for Visitation at Collins*
- Afternoon: 2-4 PM**
- Evening: 7-9 PM
- One Hour Prior to Funeral Service
* based upon availability -- MUST be verified with funeral home ** afternoon visitation time may be 3-5 PM depending of funeral home schedule.
Homeowner(s) of Family Residence
Address of Family Residence
Street Address City State ZIP Code
Phone at Family Residence
Location of Funeral Service
Name and Location of Place for Funeral Service
Name of Church
Name of Church Contact
(clergy or lay person)
Address of Church
Street Address City State ZIP Code
Church Phone
Church Website

INFORMATION TO COMPLETE DEATH NOTICE
Publish Death Notice in the following newspaper(s)
- Washington Post
- Baltimore Sun
- Frederick News Post
- OTHER (specify)
OTHER newspapers to publish death notice
Would you like to suggest memorial donations?
Memorial donations may be made to:
Non-Profit Organization
Address for Memorial Donations
Street Address Address Line 2 City State ZIP Code
Website for Memorial Donations
List of Survivors
add "the late" before the name of any deceased person and list all persons in order from oldest to youngest
Spouse
Children
Grandchildren
Great-Grandchildren
Parents
Siblings

Has Collins Funeral Home served members of your family before?
Names of family members Collins has served in the past:
Please also include exact date or approximate year of funeral
OTHER NOTES:
Email
This field is for validation purposes and should be left unchanged.

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