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Deceased Do Not Contact Registration

Fields marked with an asterisk (*) are required.

Please fill in all required fields.


Information About the Deceased

Name of Deceased
First*:
Middle Initial:
Last*:
Name Suffix:
+ Alternate Name
+ Alternate Name
+ Alternate Name
+ Alternate Name

Address of Deceased
Street*:
Apartment Number:
City*:
State*:
Zip*:
+ Alternate Address
+ Alternate Address
+ Alternate Address
 
Telephone #1:
Telephone #2:
E-mail Address of Deceased:
 
Month/Year of Death*: MM / YYYY
   / 
 
Age at Time of Death*:

Information About You

Your Name
First*:
Middle Initial:
Last*:
 
Your Relationship to the Deceased*:
 
Your e-mail address*:
Repeat your e-mail address*:
Please note: An email will be sent to your email address to verify this registration on the DMA's Deceased Do Not Contact List.
 
Word Verification*
Please enter the word you see below:
If you can't read the word, click here for a different word.

Important. Please review the information above prior to submitting this registration. Any errors in the information may reduce the effectiveness of the Deceased service.

 

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