A Dedication to Excellence That Has Remained Constant Jeter Memorial Funeral Home HOME ABOUT GALLERY CASKETS SERVICES CURRENT SERVICES CONTACT Menu HOME ABOUT GALLERY CASKETS SERVICES CURRENT SERVICES CONTACT Jeter Memorial Funeral Home HOME ABOUT GALLERY CASKETS SERVICES CURRENT SERVICES CONTACT Menu HOME ABOUT GALLERY CASKETS SERVICES CURRENT SERVICES CONTACT Vital Statistics Vital Statistics Form FIRST NAME * MIDDLE NAME AGE LAST NAME * MAIDEN NAME DATE OF DEATH TIME OF DEATH ARRANGEMENT APPOINTMENT TIME AT FUNERAL HOME AT RESIDENCE Vital Statistics DECEASED'S ADDRESS CITY/TOWN (IF OUTSIDE CITY LIMITS, SHOW RURAL) ZIP CODE CROSSOVER STREETS OR COUNTY ROADS COUNTY PLACE OF DEATH CITY/TOWN (IF OUTSIDE CITY LIMITS, PERCINCT NO.) HOSPITAL INPATIENT ER/OUTPATIENT DOA OTHER: NURSING HOME RESIDENCE OTHER(SPECIFY) IF OTHER, SPECIFY: SEX RACE MARITAL STATUS DATE OF BIRTH BIRTHPLACE (CITY AND STATE) CITIZEN FATHER'S NAME MOTHER'S MAIDEN NAME WITH FIRST NAME OCCUPATION EMPLOYER SOCIAL SECURITY NO. SURVIVING SPOUSE (IF WIFE, GIVE MAIDEN NAME) SURVIVING SPOUSE DATE OF BIRTH SURVIVING SPOUSE SOCIAL SECURITY NO. IF VETERAN, NAME WAR AND BRANCH OF SERVICE RANK AND SERVICE NO. INFORMANT'S NAME, ADDRESS, ZIP CODE TELEPHONE CERTIFICATE SIGNED BY ADDRESS TELEPHONE OTHER INFORMATION DECENDENT'S HIGHEST GRADE COMPLETED GRADES 0-12 COLLEGE 1-4 OR 5+ NEWSPAPERS: HOUSTON CHRONICLE: GALVESTON NEWS: OTHER: Biographical Information LENGTH OF TIME LIVING HERE COMING FROM RELIGION CHURCH MEMBER LIST CLUBS, NOTEWORTHY ACHIEVEMENTS, ETC. Surviving Relatives Please also supply the City and State of the relative's residence. HUSBAND/WIFE MOTHER FATHER DAUGHTERS SONS SISTERS BROTHERS GRANDCHILDREN (NO.) GREAT GRANDCHILDREN (NO.) Service Details PLACE DATE TIME CLERGY MUSIC FAMILY WILL SIT IN CHAPEL FAMILY ROOM NO. OF SEATS RESERVED NO. OF FAMILY CARS ADDRESS: PICK UP TIME: PALLBEARERS HONORARY PALLBEARERS VISITATION HOURS ROSARY/WAKE SERVICE IN LIEU OF FLOWERS Final Disposition * BURIAL ENTOMBMENT CREMATION DATE CEMETERY/CREMATORY CITY COUNTY STATE GRAVE NO. LOT SECTION BLOCK LOT OWNER IF CREMATION, DISPOSITION OF ASHES Miscellaneous CASKET MANUFACTURED BY OUTER ENCLOSURE MANUFACTURED BY CLOTHING REMOVAL BY EMBALMING BY AUTOPSY YES NO Shipping Information FUNERAL HOME ADDRESS PHONE WITH AREA CODE DIRECTOR'S NAME Memoranda Captcha If you are human, leave this field blank. Submit Form 311 N. Friendswood Dr.Friendswood, Texas 77546281.992.7200 311 N. Friendswood Dr.Friendswood, Texas 77546281.992.7200 HomeGalleryCasketsServicesCurrent ServicesContactUseful InformationPre-Need ArrangementsAfter the Funeral HomeGalleryCasketsServicesCurrent ServicesContactUseful InformationPre-Need ArrangementsAfter the Funeral E-mail Us Proud Member Website Developed in the USA, locally, by Source Web Solutions, Inc.
