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Death Certificate/Vital Information

Submit Vital Information

We provide our Vital Information Form for the purpose of allowing you and your family to submit to us, the information about your loved one for the death certificate.

If you have any questions whatsoever, please contact Church and Chapel Funeral Home at (414) 476-0052.

NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

 

Deceased Vital Statistics

 

 
 

 

PLACE OF BIRTH:

 

EDUCATION

 

 




Veteran Information

 








Survivors

 




 

 

Information about Informant / Person In Charge 

 

 
 
 




 

Locations and Quick Links

 

Brookfield (Central Office)
1875 N. Calhoun Road, Brookfield, WI 53005
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West Allis
7626 W. Greenfield Avenue, West Allis, WI 53214
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Waukesha/Pewaukee
380 Bluemound Road, Waukesha, WI 53188
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New Berlin
15250 W. National Ave. New Berlin 53151
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Cudahy
3774 E. Underwood Ave., Cudahy, WI 53110
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Pre-Planning Center
9230 W. Bluemound Road, Milwaukee, WI 53226
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