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Baca's Funeral Chapels
300 East Boutz
Las Cruces, NM 88005
575-527-2222

The following information will help begin the process of acquiring the necessary information to complete a death certificate. There are other questions that will need to be answered once you meet with one of our funeral directors. Please remember to bring the decedent's social security number and discharge notices from the Armed Services when applicable.

First Name:
Last Name:
Middle Name:
Sex:
Race:
Place of Birth: City, State:
Date of Death:
City of Death:
State of Death:
County of Death:
Location of Death:
If other, please indicate addres:
Name of the Place of Death:
Education - Primary:
Education - College:
Usual Occupation (most of life):
Last Employing Co.:
Marital Status:
Full Name of Surving Spouse:
If Wife, Provide Maiden Name:
Residence - Street Address:
City/ Town:
Inside City Limits:
County:
State:
Zip Code:
Length of Residence In County:
Father's Full Name:
Mother's Full Maiden Name:
Funeral Home Location:

For security, each spinning column above will briefly pause on a letter. Please enter the letter displayed in the corresponding box below the column. The letters do not have to be capitalized.

Pre-arrangement Form - Printer-friendly Version:

You can download the printer-friendly version of the Pre-arrangement form to your local computer from the link below. Once downloaded, open the PDF *, and enter your information on the form, then print it out on your printer. You may then either mail or fax it to us at the address or fax number below, or bring it with you when you visit.

� CLICK HERE to download the form - choose to, 'Save to Disk,' in the dialog box that appears (download times will vary depending upon connection.)

*NOTE: Adobe Acrobat Reader software is required to view this file - if you don't already have the Reader installed on your computer, it is available for free from Adobe's website - please click the icon at right to be taken to the down load page.