Start Arrangements | Corprew Funeral Home | Portsmouth, VA & the Surrounding Hampton Roads | Tradition, Integrity, Dignity and Excellence Since 1918

We are very sorry for your loss.

The following program is designed to allow us to better serve you during your time of loss.

If you have not already scheduled a meeting with one of our Funeral Directors, please contact us at 757-399-4661 .

Note: This information is used to create the official Death Certificate for the Commonwealth of Virginia. Incorrect information will incur a $60 change fee (if you have doubts about the accuracy of any of the information, please leave that field blank). Please review all information before submitting.

Step 1

Contact Information

Name *(the person in charge of making arrangements) First Last
Relationship to Deceased
Email Address *
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Best phone number at which to reach you:
Do you have an appointment scheduled with one of our staff?
YesNo
Ready for STEP 2?

Step 2 |

Decedent Information

IMPORTANT This information is needed to complete the death certificate
Name * First Last
Sex
Race
Date of Birth
City
State
Country
Date of Death
Location of Death *
Name of the Place of Death
City of Death
State of Death
Country of Death
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Education - Primary (highest level of primary education)
Education - College (highest level of college education)
Usual Occupation (most of life, not retired)
Kind of Business:
Company:
Marital Status:
Full Name of Surviving Spouse:
If Wife, Provide Maiden Name:
Residence Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Length of Residence in County:
Father's Full Name:
Mother's Full Maiden Name:
Ready for STEP 3?

Step 3

Possible Service Information

Instructions Basic thoughts about possible services for deceased
Religious Denomination:
Preferred Place of Service:
Disposition Will Be:
If Cremation, Indicate Preference for Disposition of Ashes:
Name of Church (if applicable):
Name of Cemetery (if applicable):
City and State
Is there an insurance policy on decedent?
YesNo
If Yes, Specify Insurance Type:
Other Information & Instructions
Please list any other instruction or information you would like us to have:
Ready for STEP 4?

Step 4

Veteran Information

Was Decedent Ever in the US Armed Forces?
YesNo
Is a Copy of Discharge Papers Available?
(if yes, please bring for us to copy)YesNo
Branch of Service?
Ready for FINAL STEP?

Final Step

Survivor Information

Children
We will assist you in writing the newspaper notices. Please separate each name with a comma.
Sisters and Brothers
We will assist you in writing the newspaper notices. Please separate each name with a comma.
Parents
We will assist you in writing the newspaper notices. Please separate each name with a comma.
Grandparents
We will assist you in writing the newspaper notices. Please separate each name with a comma.
Number of Grandchildren
Number of Great Grandchildren

By clicking submit you agree that the information you have submitted is accurate and correct.

Please enter any two digitsExample: 12
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