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Funeral Escort Form
This form has been modified since it was saved. Please review all fields before submitting.
For Funeral Directors Only
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.
Date of Request:
*
Deceased Last Name:
*
Deceased First Name:
*
Contact Name:
*
Contact Email Address:
*
Contact Work Phone:
*
Contact Cell Phone:
*
Funeral Home Name:
*
Funeral Home Address:
*
Date of Escort:
*
Time of Escort:
*
Location Name of Service:
*
Address of Service:
*
Location Name of Burial:
*
Address of Burial:
*
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