Lane Family Funeral Homes
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Death Certificate Request Form

Possible reasons/needs for ordering a death certificate include:

  • Life Insurance Proceeds
  • Sell or transfer stocks and bonds
  • Sell or transfer Real Property
  • Veterans Benefits
  • Social Security Benefits
  • Employee benefits and pensions
  • Bank and Loan transactions
  • IRS for Income Tax records

Thanks for taking the time to fill out our Genealogy Request Form. The information provided on this form will help Lane Family Funeral Homes complete the death certificate.

Please complete (as much as possible) the information on the form and select 'Submit Request' at the end to send the request to us.

If you have any questions whatsoever, please contact Lane Family Funeral Homes at: (330) 744-2289



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 for Death Certificate:

* Deceased First Name:
* Deceased Last Name:
Street Address:
City/Town:
County:
State:
Zip Code:
Date of Birth:
Place of Birth: City:

State:

Country:
Date of Death:
Place of Death - Location:

If other location, please indicate:


Place of Death - Name:
Place of Death - Street:
Place of Death - City:
Place of Death - State
Place of Death - County:
Full Name of Surviving Spouse:
Death Certificate Quantity Requested:
First copy: $ 10.00
Each additional copy: $ 10.00

Informant/Person In Charge Information:

* First Name:
* Last Name:
Relationship To Deceased:
* Email Address:
Telephone Number:

Other Information & Instructions

Please list any other information or instructions you would like us to have:






 

5797 Mahoning Ave.
Youngstown, OH 44515
(330) 744-2289
8387 Tod Ave.
Boardman, OH 44512
(330) 782-0222
6923 Warren-Sharon Rd.
Brookfield, OH 44403
(330) 448-6969
65 N. Broad St.
Canfield, OH 44406
(330) 533-3326
164 N. High St.
Cortland, OH 44410
(330) 637-4986
1350 N. Niles-Canfield Rd.
Mineral Ridge, OH 44440
(330) 652-4214
415 Robbins Ave.
Niles, OH 44446
(330) 652-2314
180 Garfield Dr. NE
Warren, OH 44483
(330) 392-2559
5801 Mahoning Ave.
Austintown, OH 44515
(330) 799-1002 • Fax (330) 799-1096
45 N. Broad St.
Canfield, OH 44406
(330) 533-3326
2681 E.Market St.
Warren, OH 44483
(330) 469-5506
8387 Tod Ave.
Boardman, OH 44512
(330) 782-0222
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