Full Legal Name Sex

Date of Birth Place of Birth

Marital Status Social Security #

Race Citizen of what Country

Residence Address County

City State Zip

Phone Email

Spouse (full name prior to any marriage)

Father’s Name

Mother’s Name Maiden Name

Next of Kin Relationship

Residence Address County

City State Zip

Phone Email

Highest Degree of Education

Occupation (Do not use retired)

Business/Industry (Do not use company name)

Were you in the Armed Forces? Branch

Serial Number Date Enlisted

Place of Enlistment Date Discharged

Rank at Discharge Name of Wars

Choose a PackageWhen you plan in advance, you are making choices now based on your wishes asto how your final arrangements will be carried out. Thus, you can reduce familyconcerns at the time of your death.

Simple Dignified Cremation $1195, Member* $1295, Non Member*

Just the basics, no extras - everything you need to provide for the cremationprocess in the most cost effective manner.

Honoring Our Veterans Service $1395, Member* $1595, Non Member*

An affordable tribute for the men and women that have proudly served ourcountry.

Cemetery Graveside Service $1495, Member* $1695, Non Member*

Everything you need to complete the cremation process and arrange for a digni-fied committal service for the cremated remains.

Celebration of Life Service $1695, Member* $1895, Non Member*

Everything you need to complete the cremation process and arrange for a memo-rial service that helps to celebrate the life that was lived.

All packages include:

Professional Services - Services of licensed professional staffTransfer of Decedent - Transfer from place of death (35 mile radius)Refrigeration - Use of refrigeration (24 hr period)Cremation FeeBasic Cardboard Container Temporary Container

(Each of these packages includes an alternative container for the cremation process and a temporarycontainer for the cremated remains. The packages do not include medical examiner fees, certifiedcopies of the death certificate or applicable sales tax)*These prices are effective November 1, 2012 and are subject to change without notice.

Member InformationPlease fill out the necessary information, and we will keep it in our records.The information requested below is required to complete an Iowa Certificateof Death and must be completed.

When Death OccursWhen a death occurs our staff is available 24 hours a day. Youare welcome to use our website to select from various optionsand provide needed information. However, it is imperative thatyou call us at (515) 331-6538 to let us know the death hasoccurred.

A few things to remember:One of the reasons Des Moines Cremation costs less than tradi-tional funeral homes is that we have no facilities for visitationsor viewings. What does this mean to you now that a death hasoccurred? Take your time saying goodbye to your loved one.Give other family members the option of coming to the place ofdeath to be with you. Call us when you are ready, and we willreceive your loved one into our care.

Before we proceed with the cremation process, we will needvital statistic information for legal documents such as death cer-tificate and social security notification. We will also need tosecure authorization for the cremation from the next of kin. Thiscan be done on our website, over the phone and via fax, or bymeeting at our West Des Moines arrangement office. Our funer-al director will contact you by telephone to review the informa-tion or set an appointment time.

Once the proper authorizations, permits and payments havebeen obtained, we will proceed with the cremation process. Thecremated remains can be mailed to you, delivered in our servicearea, or picked up at our West Des Moines arrangement office.This process takes approximately a week to ten days.

Visit our website to learn more about our "Peace of Mind"process, service options, urn choices, obituaries and answers tomany frequently asked questions.

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Des Moines Cremation provides affordable cremation services to families

in the greater Des Moines area. In order to keep our prices low,

we only offer services to families that experience a death in Polk, Dallas,

Warren, Story and Boone counties.

WE KEEP IT SIMPLEWe realize families have many decisions to make when a deathoccurs, and it can be an overwhelming experience. At Des MoinesCremation, we simplify the process. Using our website, families canselect packages from “simple cremation” to “celebration of lifeservices”. The website also allows families to complete all necessarydocuments and forms from the comfort of their own home or office.

WE KEEP IT AFFORDABLEWe have very limited facilities and overhead. This means the fami-lies we serve do not have to pay for visitation rooms, chapels, andreception centers they don’t use. We provide dignified cremationservices at the most affordable price.

WE KEEP IT DIGNIFIEDYour loved one never leaves our care. We own our own crematoryand it is operated by our licensed professional staff. Just becausesomeone is cost conscious doesn’t mean their loved one should notreceive the care and respect they deserve.

SIMPLE a DIGNIFIED a AFFORDABLE

DesMoinesCremation.com

(515) 331-6538

Become a Member TodayMembers of Des Moines Cremation are entitled to receive discountedprices for each of our affordable cremation packages. The vital statisticsand cremation service wishes of members will be kept on file. Memberswill receive an emailed confirmation of membership with contact informa-tion to be used at the time of death. There is a one-time $35 nonrefund-able fee for membership. Members always have the option of prepaying allfinal expenses at the discounted rate. Membership must be issued 24hours prior to time of death.

Join at DesMoinesCremation.com or call (515) 331-6538

SIMPLE a DIGNIFIED a AFFORDABLE

DesMoinesCremation.com(515) 331-6538

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