Duggan's Serra Mortuary - Caring funeral and cremation services

Time: Day: Month: Year:

Deceased First Name:
Deceased Middle Name:
Deceased Last Name:
Place of death:
Time of death:
Legal (Street) address:
City, State, Zip code:
Date of Birth:
Age:
City and State of Birth:
Social Security Number:
Veteran (bring discharge paper):
Occupation (Do not put retired):
Type of Business:
Number of years of Education:
Spouse's FirstName:
Spouse's Last Name (Maiden):
Father's First Name:
Father's Last Name:
Mother's First Name:
Mother's Last Name (Maiden):
Doctor's Name:
Doctor's Phone Number:
Last Date Seen by Doctor:
Name of Cemetery:
Street Address of Cemetery:
City, State, Zip code of Cemetery:
Person making the Arrangements:
Your relationship to the deceased:
Your Phone Number:

Open 365 days a year
Please call us to confirm an appointment.