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Death Certificate
Call: 913-815-8001
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Necessary Forms
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FAQs
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Missouri
Name of Deceased (First Name, Middle Name, Last Name):
*
*
Social Security Number of Deceased:
*
Date of Death:
*
Name of Purchaser:
*
Drivers License Number of Purchaser:
*
Direct Cremation $1095.00:
* if deceased weighs more than 300lbs additional cremation charges apply (select below under additional options) final total determined upon confirmed weight of deceased by crematory.
In Person Arrangement $400.00: By Appointment Only - Includes administration fee and meeting at facility with our director to complete the required paperwork.
Additional Mileage (County where death occurred): *
Jackson County - $0.00 - County Cremation Permit - $0.00
Clay County - $0.00 - County Cremation Permit - $0.00
Platte County - $0.00 - County Cremation Permit - $0.00
Cass County - $100.00 - County Cremation Permit - $0.00
Johnson County - $300.00 - County Cremation Permit - $0.00
Ray County - $300.00 - County Cremation Permit - $0.00
Lafayette County - $300.00 - County Cremation Permit - $0.00
Bates County - $300.00 - County Cremation Permit - $0.00
Buchanan County - $300.00 - County Cremation Permit - $0.00
Custom Option:
Amount: $
Additional Options:
Priority Cremation (within two days of receiving the cremation permit) - $295.00
Additional removal/transfer (ie organ donation, autopsy) - $195.00
Cremation container if over 300lbs - $495.00
Cremation container if over 500lbs - $695.00
Urn Filling (for transferring cremated remains into urn or keepsake not purchased from Mid States Cremation) $35.00
Custom Option:
Amount: $
Merchandise
Urns:
Basic Urn - $0.00
Walnut Scattering - $109.00
Purity Urn - $438.00
Blue Roman - $252.00
Custom Option :
Amount: $
Sales Tax 9.35% :
Death Certificates
:
0 - $0.00
1 - $14.00
2 - $25
3 - $36
4 - $47
5 - $58
6 - $69
7 - $80
8 - $91
9 - $102
10 - $113
11 - $124
12 - $135
13 - $146
14 - $157
15 - $168
16 - $179
17 - $190
18 - $201
19 - $212
20 - $223
Final Disposition
Pick up at our facility (By appointment only)
Delivery Charge for Cremated Remains - $
150.00
*For cremated remains, person arranging the cremation must be present when cremated remains are delivered and show a valid ID.
Shipping Cremated Remains by USPS Priority Mail Express - $105.00 (within U.S. only)
Name:
Shipping Address 1:
Shipping Address 2:
Shipping City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Ontario
Quebec
Nova Scotia
New Brunswick
Manitoba
British Columbia
Prince Edward Island
Saskatchewan
Alberta
Newfoundland And Labrador
Northwest Territories
Yukon
Nunavut
Shipping Zip Code:
Shipping Phone Number:
Total:
$0.00
Your Contact Information:
First Name:
*
Last Name:
*
Billing Address 1:
*
Billing Address 2:
Billing Address 3:
City:
*
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Ontario
Quebec
Nova Scotia
New Brunswick
Manitoba
British Columbia
Prince Edward Island
Saskatchewan
Alberta
Newfoundland And Labrador
Northwest Territories
Yukon
Nunavut
*
5-Digit Zip:
*
Your Email:
*
Confirm Email:
*
Phone Number:
*
Terms of Service : Accept
Do not Accept
Acknowledge receipt and review of General Price List : Yes
No
I understand that to complete the cremation process
ALL LEGAL NEXT OF KIN must sign the Authorization Form in front of a Notary Public
(Step 3) : Yes
No
I understand that all
Necessary Forms
must be submitted within 5 days of completed payment, and that after 5 days
Refrigeration Fees
of $250 per day will apply. : Yes
No
Warning - Exiting Site
X
* All death certificates ordered will have the cause of death listed
* We are unable to order
pending
death certificates
* Death Certificates being completed by the Medical Examiner/Coroner's Office may take up to 6-8 weeks to complete
YES
No