146 East Second Avenue
Roselle, NJ 07203
Phone: (732) 800-1086
Fax: (732) 382-9146

Obituaries & Tributes

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

Immediate Need

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

Pre-Arrangement

A gift to your family, sparing them hard decisions at an emotional time.

Online Immediate Need Form

Thank you for taking the time to fill out our Online Funeral Planning Form. By completing the following information at your own convenience, you should find it easier to provide correct information and have some time to think about the type of services you desire.

The information provided on this form will help the Cremation and Burial Center of NJ complete the death certificate and other required documents. In addition, this information will assist the funeral director to better understand your initial wishes.

A Cremation and Burial Center of NJ representative will review it and will be in touch with you to further discuss the details of your arrangements.

Please complete the information on the form below as much as possible and select Submit.

Please call the funeral home as soon as a death has occurred. We are available 24 hours a day.      732-800-1086
I. Biographical Information
   
Full Legal Name:
 

(First,Middle,Last,Suffix)
Also Known As (aka):
 

(First,Middle,Last,Suffix)
Address 1:
Address 2:
City Name:
State:
Zip Code:
Telephone Number:
 

(xxx-xxx-xxxx)
Date of Birth:
 

(month/day/year)
City of Birth:
State of Birth:
Country of Birth:

Race:



 



(specify below if more then one race or if you selected other) 


Decedent of 
Hispanic Origin:






 



(specify below if more then one race or if you selected other)


Highest Education Level:
Social Security Number:
 

Last known Occupation or Longest held Occupation
(retired,  unemployed are not accepted)

Occupation:
Kind of  Business/Industry:
Name of Employer:
Employer City Name:
Church Membership:

Father's Name:
 

(First,Middle,Last,Suffix)
Mother's Name:
 

(First,Middle,Last,Suffix)
Mother's Maiden Name:
 
Domestic Status at  Time of Death:
 
Spouse's Name:
 

(First,Middle,Last,Suffix)
Spouse's Maiden Name:
 

The Deceased has an appointed authorized Funeral Agent in a will.
Funeral Agent:          yes           no
Funeral Agent's Name:

The Deceased's Living Children
Biological and Legally Adopted
(do not include step-children)
Living Children
over 18 years old:
        yes             no
How Many
Children Living:
List Living
Children's Names:

The Deceased's Living Parents
Biological and Legally Adoptive
(do not include step-parents)
Living Parents:        yes               no
How Many
Parents Living:
List Living
Parent's Names:

The Deceased's Living Siblings
Biological and those related by Adoption
(do not include step-brothers or step sisters)
Living Siblings:         yes              no
How Many
Living Siblings:
List Living
Sibling Names:

II. Death Information
   
Has the Death Occurred:   yes
or  
Pre-Planning   yes
   
Date of Death:
 

(month/day/year)
Type of place where death will happen or has occurred:
 

 
Name of Facility where death will happen or has occurred:
 
Place of Death Address 1:
 
Place of Death Address 2:
 

 
Place of Death City Name:
 
Place of Death State:
 

 
Place of Death Zip code:
 

 
Place of Death Telephone Number:

 

(xxx-xxx-xxxx)
Decedent's Weight:
Decedent's Height:

III.  Informant, Next of Kin, Person Authorized to Handle Funeral, Form Filler
   
Relationship to the Decedent:
 
Informant's Full Legal Name:

 

(First,Middle,Last,Suffix)
Informant's Address 1:
Informant's Address 2:
Informant's City Name:
Informant's State:
Informant's Zip Code:

Informant's Telephone Number:
 

(xxx-xxx-xxxx)
Email Address:

IV.  Military Record
   
Veteran:
Branch of Service:
Serial Number:
Date Enlisted:
 

(month/day/year)
Date of Discharge:
 

(month/day/year)
Rank at Discharge:
 

 
Location of a Copy of Discharge (DD214):
 
Time of Military Service:

V.  Service Preferences
   
Number of Death Certificates need:
 

Obituary:
                          



 
(specify below all of the Newspaper Names

 
Obituary Written by:
 

 
Submitted to the 
Newspaper by:

 

Type of Funeral Service:
 

Package Choice:
 
   To View Packages: Cremation Packages
  
Burial Packages

If you choose Cremation please fill out this section:
   
Deceased Had a Pacemaker:              yes                       no
Choice of Urn:

 

To view our Urns please Click Here.

If you have chosen a different Urn from what is offered in the our cremation package.  Please specify:  

What is to be done with the Cremains:
 
Cemetery Name:
Cemetery City Name:
 

 
The cemetery property is in the name of:
 
Location of the original cemetery deed:
 

If you choose Burial please fill out this section:
   
Casket Choice:



 
To view our Caskets please Click Here.

If you have chosen a different Casket from what is offered in the our burial package.  Please specify:

 
Outer Burial Container:

 
To view our Outer Burial Containers please Click Here.

If you have chosen a Outer Burial Container  Please specify:


 
Disposition:
Cemetery Name:
Cemetery City Name:
 

 
The cemetery property is in the name of:
 
Location of the original cemetery deed:
 

Miscellaneous Notes and Instructions:


 
Please select one of the options below:
 
                                   Please contact me
 
                                   Please place my information on file
 
                      

Please call the funeral home as soon as a death has occurred. We are available 24 hours a day.      732-800-1086