Contact Us Form

* = Required Information

Request Form

Requestor Information

Date

Requestor Name and Relationship to Victim*

Address *

Phone

Email *

Deceased or victims

Name

Date of Birth

Date of occurrence

Briefly explain what happen to your loved ones

How did you find us?

Resources information needed (Check if applicable) Burial assistance, Total funeral costs must be under $4500 to qualify. Not eligible with life insurance or go fund me.
Cemetery plot at Wisconsin Memorial (while supply last) Family's cost is $3800 for vault, opening and closing services
Grief service referral
Crime Victim Compensation Application assistance This program reimburses up to $5000 back to families is approved
List of funeral homes

Other

Do you have a go fund me?

Yes

how much? This will be checked.

Do you have Life Insurance?

Yes

how much?

Is your loved one at Medical Examiner's Office

Do you have a go fund me?

Yes

Have you arranged funeral yet

Yes

Other

Other Information

We provide families with informational resources when we are contacted. Victims of Milwaukee Violence do not pay for funerals. 100% of our funding is for our mission. Check out our grief support on Facebook & Instagram every Saturday morning @ 8am. Victims of Milwaukee Violence

Do we have your persmission to send our condolences on social media

Yes

Name

Initials