Request for Support

Complete the form below to make your request for assistance. If arrangements have been made with a funeral director and/or a bank account has been set up to help pay for the funeral services, please complete the Authorization for Release of Account Information form. Make two copies of the completed form and have both copies notarized. Turn in one notarized copy to the Funeral Home and one notarized copy to the SonShine Charitable Fund.

About the Child

Child's First Name

Child's Last Name

Child's Date of Birth

Child's Date of Death

Cause of Death

About the Family

First Name

Last Name

Relationship to Deceased

Phone Number

Address

Address

2nd Street Address

City

State

Zip Code

Funeral Home Information

Funeral Home

Contact Person

Address

Phone