Arrangement Form

Please fill out the form below to begin the funeral arrangement process.  Click here to download our arrangement folder to print and fill out.

Be sure to send us an e-mail at email@thompsonfuneralchapel or call us at 623-923-1780 if you have any questions.

Arrangement Form

Descedant's Legal Name (required)

AKA's (if any)

Date of Death

Sex (required)
 Male Female

Social Security Number

Date of Birth

Age

(If under one year)
Months: Days:

(If under one day)
Hours: Minutes:

Place of death (in hospital)
 Inpatient ER/Outpatient Dead on Arrival

Place of death (other than hospital)
 Residence Hospice Facility Nursing Home Other

Place of death (other than hospital)
 Residence Hospice Facility Nursing Home Other

Facility Name

City, State, & Zip Code
City: State: Zip Code:

County of Death

Birthplace (City, State, and or Foreign Country)

Marital Status (at time of death)

Name of Surviving Spouse (maiden name if wife)

Name of Surviving Spouse (maiden name if wife)

Descedants Street Address

City & County

State & Zip Code

Serve in Armed Forces?
 Yes No

Was Descendant of Hispanic Origin?
 No, Not Spanish, Hispanic, or Latino Yes, Mexican, Mexican American, Chicano Yes, Puerto Rican Yes, Cuban Yes, Other Unknown

Descedant's Race(s)
 White Black, African American Native Hawaiian Asian Indian Chinese Filipino Japanese Guamanian or Chamorro Korean Vietnamese Somoan Other Asian Other Pacific Islander Other Unknown American Indian or Alaskan Native

If American Indian, Specify up to 4 Tribes

Occupation/Industry

How Long in Arizona?

Highest Level of Education
 1-8 9-12 (no diploma) High School Grad or GED Refused Unknown Not Classifiable Some College Associates Degree Bachelors Degree Masters Degree Doctorate/Professional Degree

Father's Name (first, middle, last)

Mother's Name (first, middle, last)

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