Funeral Request — Hakim's Islamic Funeral Home

Funeral Request & Authorization Form

The following form is for the descendent and must be completed to initiate any funeral service request through Hakim’s Islamic Funeral Home. Please complete the funeral inquiry to the right to its entirety and Authorization Form. If you have any questions or problems completing please contact us 443-802-3843 or email contact@hakimsislamicfuneral.com

*Disclaimer the information provided is secured & will be submitted to funeral home staff to initiate the funeral process.

Vital Statistics

Decedent's Name

First Name

Last Name

Middle Name

Date of Death

Place of Death

Social Security Number

Gender

Date of Birth

Height

Weight

Birth State or Country

Usual Residence of Decedent (Street & Number/City/State/Zip code)

US Citizen

Martial Status

Name of Spouse

Served in US military

Was decedent of Hispanic Origin? If yes, specify Cuban, Mexican, Puerto Rico, etc.

Race

Highest Level of Education Completed

Decedent's Usual Occupation

Kind of Industry

Father's Name

Father's Middle Name

Mother's Name

Mother's Middle Name

Next of kin's Name/Relationship to Deceased

Phone

(###)

###

####

Cemetery for Burial

Number of family members participating in Ghusl/wash

Funeral Request & Authorization Form

Vital Statistics

Location

Hours

Contact