Forms

file

New York State Cremation Authorization Form

Click on the graphic on the left to download the file.

Vital Statistics Information

This form will be used to complete death certificate. All required items are identified with an asterisk. If you do not have the complete information, please type unknown in the field and we will get the information at a later time.

First Name Last Name

Deceased's Address

Education

Occupation

Type of Industry

Military

Spouse's Name

First Name Last Name
First Name Last Name
English, Irish, French, German, etc.

Informant's Information

Your Information

First Name Last Name

Address

Signature*

© 2021 Levine Memorial Chapel. All Rights Reserved. Funeral Home website by CFS & TA | Terms of Use | Privacy Policy