Obituaries

Mary Urban
B: 1938-10-28
D: 2017-02-20
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Urban, Mary
Ruth Case
B: 1919-09-28
D: 2017-02-20
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Case, Ruth
Gordon Cooper
B: 1931-08-08
D: 2017-02-19
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Cooper, Gordon
Wanda Babcock
B: 1926-04-22
D: 2017-02-15
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Babcock, Wanda
William Dailey
B: 1932-02-05
D: 2017-02-14
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Dailey, William
Lyndell Bush
B: 1931-07-03
D: 2017-02-13
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Bush, Lyndell
Cheryl Scott
B: 1945-09-16
D: 2017-02-13
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Scott, Cheryl
Shirley Muzynski
B: 1942-11-17
D: 2017-02-11
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Muzynski, Shirley
Martin Antiuk
B: 1928-03-01
D: 2017-02-08
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Antiuk, Martin
Kenneth Kelly
B: 1932-04-24
D: 2017-02-07
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Kelly, Kenneth
Mark Lowell
B: 1955-12-30
D: 2017-02-07
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Lowell, Mark
Joseph Gilman
B: 1930-05-29
D: 2017-02-07
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Gilman, Joseph
David Hovey, III
B: 1990-09-23
D: 2017-02-06
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Hovey, III, David
Elizabeth Clark
B: 1928-10-23
D: 2017-02-05
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Clark, Elizabeth
Marc Zhang
B: 2015-01-23
D: 2017-02-05
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Zhang, Marc
Phyllis Ward
B: 1923-01-20
D: 2017-02-03
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Ward, Phyllis
Barbara Deming
D: 2017-02-02
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Deming, Barbara
Kenneth Gleason
D: 2017-01-31
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Gleason, Kenneth
Virginia Jackson
B: 1939-09-19
D: 2017-01-30
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Jackson, Virginia
Grace Brophy
B: 1934-05-06
D: 2017-01-29
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Brophy, Grace
Lucia Maccarone
B: 1930-10-03
D: 2017-01-24
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Maccarone, Lucia

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I. Biographical Information

Full Name:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number:
(xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:        
Please select Grade/Years of Education completed:        
Social Security Number: For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded You In Death
Your Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:
         

II. Military Record

Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. Service Preferences

Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:
         

Miscellaneous Notes and Instructions:

             

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Please place my information on file

         
       

 

 

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