Serenity Funeral Chapel | 502 2nd Avenue North | Twin Falls, ID 208-733-0991

Rock Creek Celebration Center a.k.a. "Downtown": A multipurpose event venue hosting Last Call Pub & Catering | 320 Main Avenue North | Twin Falls, ID 208-595-2628

Serenity Funeral Chapel
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Rock Creek Downtown
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At-Need Online Form

At-Need Arrangement Form

We are very sorry for your loss and stand ready to assist you in your time of need. If you have not already scheduled a meeting with us, please call us.

If you prefer, you are welcome to send us information using the form below. We understand that you may not have access to all of the details below (or would prefer to provide in person). You are welcome to fill out as much or as little as you prefer. We will cover the remainder when we meet with you.

Please complete the first form to the best of your knowledge for Vital Statistics

Click on the submit button at the end of the section

This form provides us with the certifier information for the death certificate and the legal person in charge for making the arrangements.

If there is a Power of Attorney for Healthcare, please email a copy to serenity funeral serenityfuneralchapelTF@gmail.com

Click on the submit button at the end of the form.

Decedent's Name:

Name at Birth:

Gender:

Date of Birth:

Social Security Number:

Occupation:

Type of Business/Industry:

Residence Address:

City:

State:

Zip Code:

Birthplace:

Marital Status:

Surviving Spouse (Maiden Name):

Ancestry:

Race:

Hispanic Origin:

U.S. Armed Forces Member:

Highest Education:

Father's Name & State of Birth:

Mother's Name (First & Maiden) & State of Birth

Informant's Name:

Relationship:

Informant Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Email

Date of Death:

Has a Doctor / Coroner Been Notified? (If deceased passed at home)

Yes

No

Has the Body Been Released for Removal?

Yes

No

Do You Have a Prearrangement on File with Us?

Yes

No

If Yes, Under What Name?

Burial or Cremation?

Cremation

Burial

Embalming

Viewing

Do we have permission to post a death notice and set up a tribute page?

Yes

No

Do you permit us to Cremate?

Yes, this constitutes written authorization

No

Do You Permit Us to Embalm?

Yes, this constitutes written authorization

No

If Yes, Who Has Granted Permission?

Is there a POA for Healthcare? Please provide contact information below. This person would have authority in making arrangements.

Name of Person Legally Responsible for Disposition: (If same as informant just state informant)

Relationship to Deceased:

Street Address

City:

State / Province

Zip / Postal Code

Primary Phone Number:

Email address of legal person in charge of arrangements

Best Time to Reach (via phone)

Thank you for filling out a pre arranagement form.

We will be in touch with you as soon as possible.

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