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Home
Obituaries
About Us
Location
Services
- Our Services
- Merchandise
Pre-Plan
Veterans
Resources

Push button for menu

Home
Obituaries
About Us
Location
Services
- Our Services
- Merchandise
Pre-Plan
Veterans
Resources

Deceased Information

If you do not wish to submit your information online, please download and print our information form,

Click Here to Download and return the completed form to our offices:

Southern Nevada Mortuary
730 Front Street
Caliente, Nevada 89008

Information about the deceased

Last Name

First Name

Middle Name

Maiden Name

Sex

Father's Name

First

Middle

Last

Mother's Name

First

Middle

Last

Race

African-AmericanCaucasianNative AmericanHispanicAsian

Country of origin

Date of birth

City of birth

State

OR Country if not USA

Date of Death

City of death

State of death

County of death

Location of death

Location (if other)

Name of the place of death

Social Security Number

Education

Primary Education

College Education

Usual occupation (most of life)

Type of business

Company (optional)

Marital status

Surviving Spouse

If wife, enter maiden name

Surviving spouse address

Street

City

State/Province

ZIP/Postcode

Mother's full name

Father's full name

Type of disposition

Disposition will be

If cremation, disposition of ashes

Preparation and viewing

Viewing/embalming preference

I authorize Southern Nevada Mortuary to embalm

Name of authorizing person

Relationship to deceased

Veteran information

Was the decendent ever in the US Armed Forces?

YesNoIf no, continue to the next section

Branch of service

Date enlisted

Date discharged

Honorable discharge

YesNo

Service/Serial number

Copy of discharge papers is available

YesNo

Informant information

Name of person in charge

Relationship to deceased

Address

Street

City

State/Province

ZIP/Postcode

Home Telephone

Cell phone

Email Address

Funeral/memorial service information

Preferred place of service

Religious denomination

Is there pre-need funeral insurance on decedent?

YesNo

If yes, specify type

Memorials & donation preferences

Please list memorials or charitable donations that you'd like listed in the obituary

Special instructions

Optionally use the area below to provide additional information or instructions to us.

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In this section

Deceased Information

Obituary Information

Program Outline

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Deceased Information Form

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

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Immediate Need

We stand ready to assist you. If a death has occurred, please call us on the number below:

1-775-726-3779

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Southern Nevada Mortuary
| 730 Front Street
| Caliente, NV 89008
| Tel: 1-775-726-3779
| Fax: 1-775-726-3533
| southernutahmortuary@gmail.com

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Southern Nevada Mortuary
| 730 Front Street
| Caliente, NV 89008
| Tel: 1-775-726-3779
| Fax: 1-775-726-3533
| southernutahmortuary@gmail.com

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