Mortuary Assistance Request

This form must be completed by a representative from a mortuary that is already on file with us. That can be done here.

Our family foundation is honored to provide assistance to families who have experienced the loss of an infant and who would be blessed by our gift. Please express our love and condolences at this time of great sorrow and heartbreak in the lives of the family involved. We have experienced the same type of loss in our family and truly understand what they are going through. They are in our thoughts and prayers.

We apologize for this short intrusion, but in order for us to continue to help others in like circumstances; we must comply with government regulations that require us to collect data when we make charitable contributions. All information provided will be protected by the Protection of Personal Information Act, Utah Code, Title 13, Chapter 44, Section 20. We do not share this data with anyone else for any reason.

Please provide the following information:

Family Information

Parent Name(s)

Family Size

Annual Income

Name of Child

Date of Birth

Date of Death

Wholesale cost of casket

Notes

Certification of Mortuary

I believe that the above-named individual(s) is/are in need of the assistance which is noted herein.

Name of Mortuary

Mortuary Phone Number

Mortuary Representative

Mortuary Representative Position

Mortuary Contact Email

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Request Assistance

Payments will be made directly to the mortuary.

If you have questions, please call: 801-294-7040, or Email us at: contact@beattiefamilyfoundation.org