Obituaries

Rose "Eileen" Sears
B: 1934-09-27
D: 2020-03-29
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Sears, Rose "Eileen"
Wladyslawa Rokosz
B: 1927-01-01
D: 2020-03-27
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Rokosz, Wladyslawa
Rebecca Hindermeier
B: 1984-09-03
D: 2020-03-25
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Hindermeier, Rebecca
Edward Kohlberger
B: 1928-07-14
D: 2020-03-23
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Kohlberger, Edward
Orlando Di Domizio
B: 1936-06-27
D: 2020-03-23
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Di Domizio, Orlando
Albert Elliott
B: 1931-08-15
D: 2020-03-23
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Elliott, Albert
Ann Easto
B: 1939-04-02
D: 2020-03-21
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Easto, Ann
Linda Grieve-Lewis
B: 1946-03-01
D: 2020-03-19
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Grieve-Lewis, Linda
Edith Barton
B: 1927-08-26
D: 2020-03-18
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Barton, Edith
Edythe Fawcett
B: 1932-03-23
D: 2020-03-18
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Fawcett, Edythe
Marjorie Storey
B: 1928-03-02
D: 2020-03-17
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Storey, Marjorie
Lloyd Leidens
B: 1923-02-22
D: 2020-03-17
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Leidens, Lloyd
Shannon Burnside
B: 1982-08-17
D: 2020-03-11
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Burnside, Shannon
Maddelyn Bui (Nunn)
B: 2020-03-11
D: 2020-03-11
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Bui (Nunn), Maddelyn
Marlene Brook
B: 1941-06-05
D: 2020-03-10
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Brook, Marlene
Dennis Sears
B: 1950-09-29
D: 2020-03-09
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Sears, Dennis
Dorothy Ness
B: 1924-05-04
D: 2020-03-07
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Ness, Dorothy
Ross Bury
B: 1930-07-15
D: 2020-03-07
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Bury, Ross
Eleanor Ham
B: 1925-08-09
D: 2020-03-07
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Ham, Eleanor
Leonard Lynch
B: 1939-09-10
D: 2020-03-06
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Lynch, Leonard
Angela Megraw
B: 1931-08-30
D: 2020-03-03
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Megraw, Angela

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55 Charing Cross Street
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:

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