Immediate Need

If A Death Has Just Occurred

Immediate Need Form

Free Text

PERSONAL INFORMATION OF THE DECEASED

First Name*

Middle Name*

Last Name*

Date of Birth*

Date of Death*

Time of Death

Social Security Number*

Free Text

PREPARATION INFORMATION

Has a Doctor / Coroner Been Notified?

Do you permit us to embalm the body?

Has the Body Been Released for Removal?

Do You Permit Us to Cremate the Body?

If Yes, Who Has Granted Permission?

Free Text

PHYSICIAN INFORMATION

Name of Doctor Signing Death Certificate*

Email Address*

Business Telephone*

Street Address*

City*

State*

Zip Code*

Free Text

PERSONAL INFORMATION OF PERSON LEGALLY RESPONSIBLE FOR DISPOSITION

First Name*

Middle Name*

Last Name*

Relationship to Deceased*

Street Address*

City*

State*

Zip Code*

Primary Phone Number*

Secondary Phone Number

Best Time to Reach Via Phone*

Do you have arrangements on file with us?

If Yes, Under What Name?

IMMEDIATE SUPPORT FOR YOUR FAMILY'S NEEDS

If A Death Has Just Occurred

Immediate Need Form

Services

Cemetery

Resources

Leavitt's Mortuary & Aultorest Memorial Park

Leavitt's Mortuary & Aultorest Memorial Park is a trusted funeral home and cemetery in Ogden, Utah, providing funeral, cremation, and burial services to families across Weber County.

Follow Us