Obituaries

Arthur Slanetz
B: 1926-03-12
D: 2017-07-19
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Slanetz, Arthur
Anthony Angelo
B: 1992-05-13
D: 2017-07-18
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Angelo, Anthony
Antoinette LaBreck
B: 1926-02-22
D: 2017-07-17
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LaBreck, Antoinette
Jacqueline Ferracci
B: 1962-01-06
D: 2017-07-15
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Ferracci, Jacqueline
Teresa DeLisa
B: 1932-02-26
D: 2017-07-14
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DeLisa, Teresa
Douglas Quagliaroli
B: 1918-08-27
D: 2017-07-14
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Quagliaroli, Douglas
John Hunter
B: 1960-02-24
D: 2017-07-14
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Hunter, John
Mary Champion
B: 1940-05-20
D: 2017-07-13
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Champion, Mary
Heather Bray
B: 1973-08-07
D: 2017-07-13
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Bray, Heather
Catherine Cassotta
B: 1929-02-10
D: 2017-07-11
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Cassotta, Catherine
Matthew Porcello
B: 1940-02-29
D: 2017-07-10
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Porcello, Matthew
Barbara Squires
B: 1931-06-07
D: 2017-07-08
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Squires, Barbara
Michael Cleary
B: 1961-09-30
D: 2017-07-08
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Cleary, Michael
Henry Burnell
B: 1926-04-06
D: 2017-07-08
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Burnell, Henry
Angela Davis
B: 1966-12-06
D: 2017-07-08
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Davis, Angela
Joanne Chadbourne
B: 1928-09-30
D: 2017-07-06
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Chadbourne, Joanne
Martha Cooper
B: 1932-08-09
D: 2017-07-05
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Cooper, Martha
John Vallee
B: 1930-12-14
D: 2017-07-05
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Vallee, John
Jeffrey West
D: 2017-07-05
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West, Jeffrey
Janina Kucner
B: 1928-12-06
D: 2017-07-03
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Kucner, Janina
Brian Dusza
B: 1967-10-16
D: 2017-07-01
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Dusza, Brian

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Phone: (860) 749-2244
Fax: (860) 763-2815

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I. Biographical Information
 
Full Name:
Date of Death:
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 In Death
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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