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On-line At Need Form

Thanks for taking the time to fill out our At Need Form. By completing the following information at your own convenience, you should find it easier to provide correct information and have some time to think about the type of services you desire.

The information provided on this form will help Iles Funeral Homes complete the death certificate and other required documents. In addition, this information will assist the funeral director to better understand your initial wishes. Relaying required statistical information can be time consuming. Our desire is to help expedite the final arrangement conference at the funeral home and make the process a little more comfortable.

Please complete (as much as possible) the information on the form and select Submit Information at the end to send the information to us. You may also print out the form and bring it with you to the arrangement conference or fax.

If you'd prefer, a printer-friendly version of this form is also available for you to download and fill out manually. CLICK HERE for further instructions and the download link, if interested.

If you have any questions whatsoever, please contact Iles Funeral Homes at: 515-270-8007



NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

 Deceased Vital Statistics for Death Certificate

* First Name:
* Last Name:
Middle Name:
Sex:
Race:
Date of Birth:
Place of Birth: City:

State:

Country:
Date of Death:
City of Death:
State of Death:
County of Death:
Location of Death:

If other, please indicate address:
Name of the Place of Death:
Education
Usual Occupation (most of life):
Kind of Business:
Company:
Marital Status:
Full Name of Surviving Spouse:
If Wife, Provide Maiden Name:
Residence - Street Address:
City/Town:
Inside City Limits:
County:
State:
Zip Code:
Length of Residence In County:
Father's Full Name:
Mother's Full Maiden Name:

 Type of Disposition

Disposition Will Be:
If Cremation, Indicate Preference For Disposition of Ashes?:
Name of Cemetery (if applicable):
City:
State:

 Veteran Information

Was Decedent Ever In the US Armed Forces?: Yes No (if no, continue to next section)
Branch of Service:
Date Enlisted:
Date Discharged:
Honorable Discharge: Yes No
Military Serial Number:
Is A Copy of Discharge Papers Available? Yes No (if no, please bring for us to copy):

 Informant/Person In Charge Information

* First Name:
* Last Name:
Relationship To Deceased:
* Email Address:
Address:
City:
State:
Zip Code:
Telephone Number:

 Funeral/Memorial Service Information

Preferred Place of Service:
Religious Denomination:
Is there At Need Funeral Insurance on decedent?: Yes No
If Yes, Specify Insurance Type:
(i.e., Forethought, Purple Cross, trust, etc.)

 Other Information & Instructions

Please list any other instruction or information you would like us to have:





 At Need Form - Printer-friendly Version

You can download the printer-friendly version of the At Need Form to your local computer from the link below. Once downloaded, open the PDF *, and enter your information on the form, then print it out on your printer. You may then either mail or fax it to us at the address or fax number below, or bring it with you when you visit.

»   CLICK HERE to download the form - choose to, 'Save to Disk,' in the dialog box that appears (download times will vary depending upon connection.)

Get Adobe Acrobat Reader* NOTE: Adobe Acrobat Reader software is required to view this file - if you don't already have the Reader installed on your computer, it is available for free from Adobe's website - please click the icon at right to be taken to the download page.

Mail completed forms to the following address:

Iles Funeral Homes
6337 Hickman Road
Des Moines, IA 50322

Please call with any questions: 515-270-8007


 

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