I.
Biographical Information |
| Full
Name: |
|
| Address1: |
|
| Address2: |
|
| City
Name: |
|
| Province: |
|
| Postal
Code: |
|
| Telephone
Number: |
(xxx-xxx-xxxx) |
| Email
Address: |
|
| Date
of Birth: |
(month/day/year) |
| City
of Birth: |
|
| Province
of Birth: |
|
| Social
Insurance Number: |
For
security reasons, we will contact
you to complete the pre-arrangement. |
| Residence
History: |
|
| Father's
Name: |
|
| Father's
City
of Birth: |
|
| Mother's
Name: |
|
| Mother's
City
of Birth |
|
| 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: |
|
| Time
of Military Service: |
|
| Military
Honours 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:
|
Please
select one of the options below:
Please send me
information on funeral planning
Please contact me to schedule an
appointment
Please place my information on file |
|
