2. For Funeral Directors Only
4. The Loudoun County Sheriff's Office requires 48-hours notification to confirm escort. You will receive an email verifying receipt and confirming availability for the escort.
   
   Please complete the information below. All fields are required.
6. FUNERAL HOME INFORMATION
8. Funeral Home Name:*
10. Funeral Home Phone:*
11. Funeral Home Address:*
13. Funeral Home Contact Person:*
14. Contact Email Address:*
16. Contact Cell Phone: *
18. DECEASED
21. First Name:*
22. Last Name:*
24. SERVICE LOCATION
26. Location Name:*
27. Service Address:*
29. BURIAL INFORMATION
31. Location Name:*
32. Address of Burial:*
34. ESCORT INFORMATION
36. Date:*
37. Time:*
39. ADDITIONAL INFORMATION
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit Submit and Print

* indicates a required field