Thank you for choosing Blessing Cremation Center, we look forward to serving you and your loved ones with dignity and respect.  Below you will find a "Vital Statistics" form that will provide the State with all information required by law.  Additionally, you will find our "Cremation Authorization and Release" form, which is required to be signed by the next of kin or power of attorney before our services can be rendered.  


Vital Statistics Information

The following is a form to obtain the information required by the State of Ohio for vital statistics purposes.  Please complete all sections of this form.  

 

Please complete the form below

Decedent's Legal Name *
Decedent's Legal Name
If Applicable
Date of Death *
Date of Death
Numbers Only
Date of Birth of Deceased *
Date of Birth of Deceased
City and State
Residence of Deceased *
Residence of Deceased
Surviving Spouse's Name *
Surviving Spouse's Name
If wife, give name prior to first marriage?
Decedent's Race *
You may select more than one.
Decedent's Fathers Name *
Decedent's Fathers Name
Decedent's Mothers Name *
Decedent's Mothers Name
Prior to First Marriage
Informant's Name *
Informant's Name
Next of Kin, Funeral Home's Point of Contact
Informant's Mailing Address *
Informant's Mailing Address
Address of Death *
Address of Death
If not institution, please state "home."
 

Cremation Authorization and Release Form

Click here to download our "Cremation Authorization and Release" Form

 

Once you have completed the form you can scan it to info@BlessingCremation.com or fax it to 216-662-1229.