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Comptroller's Office
Ceremonial Documents
Bereavement Resolution Request Form

Bereavement Resolution Request

Please include precise contact information. You may also print and fax this form to (410) 685-4416. You will be contacted when the resolution is ready for pickup. Due to time constraints, postal mail is not recommended. For questions or additional information, please call the office. Our telephone number is (410) 396-4755.

First and last name of person submitting request / contact person: *

Daytime Telephone Number: *

Mobile Telephone Number: *

Email address: *

Please provide the full name of the deceased: *

Please provide the date of the service: *

Month

Day

Year

In the spaces listed below please provide the names of IMMEDIATE FAMILY and HOUSEHOLD MEMBERS only and relationship to the deceased

First Name Only:

Relationship:

First Name Only:

Relationship:

First Name Only:

Relationship:

First Name Only:

Relationship:

First Name Only:

Relationship:

Please provide the name of the funeral home and the place where the service is being held: *

Personal Information About the Deceased: *

Leave this field blank