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Deceased Name:
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My Name & Relationship to
Deceased
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My Address
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My E Mail address
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Please forward a recent photo of the Deceased to the address below ( to use
on the Memorial Folder and help prepair the body for the visitation.-Please
attach a .jpg format to email
banister@windstream.net
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Vital Information About the Deceased
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Last Name :
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First Name :
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Middle Name :
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E mail address to use
in our
Guestbook/Facebook
program
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Sex :
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Female
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Male
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Marital Status :
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Social Security # or bring SS
card when you come in
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Date of Birth :
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Place of Birth :
City,County,State
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Spouse's Full Name
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Father's Full Name
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Mother's Full Name
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Mother's Maiden Name
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Usual Occupation
(most of Life)
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Kind of Business
and Company
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Military Records:
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Branch of Service
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Serial Number:/Social
Security Number
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Date Enlisted
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Rank at Discharge
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Date of Discharge
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Name of Wars, Medals
Commendations,
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Note : A "DD214" is required as proof of Military Service.
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Funeral Arrangements
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Religious Preference
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Place of
Visitation
Service
Interment
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Clergy, singers, piano
players, Music, Pallbearers
In lieu of flowers, florist,
other.
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Family:
Brothers and city of residence,
Sisters and city of residence
Children
Grand Children
Special Friends
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