Funeral Escort Form

2. For Funeral Directors Only

4. 
   

6. 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.

8. 
   

10. Date of Request:*

12. Deceased Last Name:*

13. Deceased First Name:*

15. Contact Name:*

16. Contact Email Address:*

18. Contact Work Phone: *

19. Contact Cell Phone:*

21. Funeral Home Name:*

22. Funeral Home Address:*

24. Date of Escort:*

25. Time of Escort:*

27. Location Name of Service:*

28. Address of Service:*

30. Location Name of Burial:*

31. Address of Burial:*

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field