Indigent_Funeral_Referral_(Pinellas_County)_watermarked_.pdf

This is an Indigent Cremation Referral form used by Pinellas County, Florida to process applications for indigent funeral and cremation services. The form serves as the intake document for individuals without financial means or next of kin who require burial or cremation assistance. The referral captures comprehensive information about the deceased, including personal demographics (name, Social Security number, date of birth, date of death, sex, and race), cause of death, marital status, and residential addresses at the time of death and previous addresses if applicable. The form also documents contact information for the responsible party or next of kin, including their name, Social Security number, relationship to the deceased, and contact details. The form is submitted to Pinellas County's administrative offices located at 440 Court Street, 2nd Floor, Clearwater, Florida 33756.

The referral form collects critical eligibility and service determination information, including whether the deceased was a veteran, eligible for Social Security death benefits, and the condition of the body. It also documents family consent for cremation or burial preferences and notes any relevant medical information such as infectious disease status, body deterioration, or autopsy results. The form indicates that proposals for indigent burial and cremation services are being solicited from qualified providers within Pinellas County, with consideration given to all providers meeting minimum qualifications. The document includes fields for vendor documentation and cross-out sections for administrative purposes, suggesting ongoing management and tracking of referrals through this standardized intake process.