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Online At-Need Funeral Planning

You can get a head start on the process by completing as much of this online form as possible. We recognize you may not know everything right at this moment, but what you do know will be invaluable to your Funeral Director. Submitting this form will surely expedite the funeral arrangement process.

I. Biographical Information
 
Full Name of Deceased:
Date of Death:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number:  
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number:
Residence History:
Father's Name:
Mother's Name:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Occupation:
Business Type:
Company Name:
Religious Denomination:

II. Military Record

Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
   
   
   
   

III. Service Preferences

Type of Service: Direct/Immediate Cremation
Person in Charge of Arrangements:
Disposition:

Miscellaneous Notes and Instructions:

Please select one of the options below:

Please send me information

Please contact me to schedule an appointment

Please place my information on file


 

 

 

 

 

 

 

 

Daily Grief Support by Email

Grieving doesn't always end with the funeral: subscribe to our free daily grief support email program, designed to help you a little bit every day, by filling out the form below.

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It's hard to know what to say when someone experiences loss. Our free weekly newsletter provides insights, quotes and messages on how to help during the first year.

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Immediate Need

If you have immediate need of our services, we're available for you 24 hours a day.

Obituaries & Tributes

It is not always possible to pay respects in person, so we hope that this small token will help.

Pre-Arrangement

Dying is one of the few events in life that's certain to occur, yet one we rarely plan for. Should we spend more time preparing for a two week vacation than we do our last days on Earth?

Proudly Serving the Communities of Wallington and Bergen County; Essex County; Middlesex County; Monmouth County; Morris County; Passaic County; Union County: Rockland County New York

(973) 779-4664 Warner Wozniak Funeral Service A Direct/Immediate Cremation Provider
Executive Director Brian J. Warner, NJ Lic. No. 4587
Wallington, NJ 07057
Email: warnerwozniakfs-2011@yahoo.com
(973) 779-4664 Warner Wozniak Funeral Service A Direct/Immediate Cremation Provider
Executive Director Brian J. Warner, NJ Lic. No. 4587
Wallington, NJ 07057
Email: warnerwozniakfs-2011@yahoo.com
(973) 779-4664 Warner Wozniak Funeral Service A Direct/Immediate Cremation Provider
Executive Director Brian J. Warner, NJ Lic. No. 4587
Wallington, NJ 07057
Email: warnerwozniakfs-2011@yahoo.com
(973) 779-4664 Warner Wozniak Funeral Service A Direct/Immediate Cremation Provider
Executive Director Brian J. Warner, NJ Lic. No. 4587
Wallington, NJ 07057
Email: warnerwozniakfs-2011@yahoo.com
(973) 779-4664 Warner Wozniak Funeral Service A Direct/Immediate Cremation Provider
Executive Director Brian J. Warner, NJ Lic. No. 4587
Wallington, NJ 07057
Email: warnerwozniakfs-2011@yahoo.com