Funeral Request

webmaster@pgrny.org

Form date: 01/01/2026
We recognize and are grateful for the sacrifices that our military families and first responders make on our behalf. Please know that we share in your loss.

We MUST have an invitation from an IMMEDIATE family member.
We do our utmost to honor all mission requests - even a Short Notice Mission (within 48 hours of the first date of the funeral) requests. Please be sure that spelling of the deceased name is correct, as this information is very important.
You will receive an immediate confirmation email of your request. If you do not receive this confirmation, please first check your Spam/Junk email folder. If you still did not receive a confirmation, contact us at webmaster@pgrny.org

You will hear from a PGRNY member shortly.
Thank you.

Today's Date

First Name

Last Name

Phone Area code and phone number only, dashes will automatically be added.

Your Relationship to the Deceased

If you are not an IMMEDIATE family member, please complete the following.

Family Contact - First Name

Family Contact - Last Name

Family Contact - Phone Area code and phone number only, dashes will automatically be added.

Family Contact Email

About the person to be Honored

Name of Person to be Honored

Date of Death

Branch of Service

Explain Other

DD-214 Available?

Yes

Unsure

Honorable Discharge

Yes

Unsure

Approximate Date of Military Service

Other Military Service Details

Information about the Funeral Services

First Date of Funeral Services

Name of Funeral Home

Funeral Home Contact Person Name

Funeral Home Phone Area code and phone number only, dashes will automatically be added.

Funeral Home Address

Funeral Home City

Funeral Home Zip Code Five-digit zip code only.

Cemetery Name

Cemetery Address

Cemetery City

Cemetery Zip Code Five-digit zip code only.

Any other information/comments

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Funeral Request Mission Request Form

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