Obituaries

Mary Botermans
B: 1937-06-10
D: 2019-04-17
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Botermans, Mary
Edward Mazurek
B: 1986-10-22
D: 2019-04-17
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Mazurek, Edward
Francis More
B: 1971-08-12
D: 2019-04-17
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More, Francis
Gordon Amirault
B: 1952-06-08
D: 2019-04-13
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Amirault, Gordon
Patricia Staats-Greer
B: 1962-07-10
D: 2019-04-12
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Staats-Greer, Patricia
Margaret Cavin
B: 1926-06-29
D: 2019-04-11
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Cavin, Margaret
Pauline Robson
D: 2019-04-09
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Robson, Pauline
Sharon Woodcock
B: 1949-05-01
D: 2019-04-08
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Woodcock, Sharon
Wayne Baldwin
B: 1938-06-22
D: 2019-04-08
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Baldwin, Wayne
Santina Di Domenico
B: 1931-10-28
D: 2019-04-07
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Di Domenico, Santina
Connie Peycha
B: 1970-08-21
D: 2019-04-07
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Peycha, Connie
Robert Male
B: 1981-05-06
D: 2019-04-06
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Male, Robert
John Harris
B: 1929-08-11
D: 2019-04-04
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Harris, John
Betty Rivett
B: 1927-07-24
D: 2019-04-01
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Rivett, Betty
Ronald Dawson
D: 2019-03-30
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Dawson , Ronald
Donald Johnson
B: 1933-05-28
D: 2019-03-30
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Johnson, Donald
Melvin Kerr
B: 1933-02-02
D: 2019-03-29
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Kerr, Melvin
Yolonda Penner
B: 1928-02-21
D: 2019-03-29
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Penner, Yolonda
Jack Slater
D: 2019-03-26
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Slater, Jack
Kenneth Chapin
B: 1934-02-04
D: 2019-03-22
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Chapin, Kenneth
Lawrence Hotte
B: 1946-08-16
D: 2019-03-21
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Hotte, Lawrence

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Brantford, ON N3R 2H4
Phone: 519-753-8655
Fax: 519-753-1195

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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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