Obituaries

Laurie Duclos
B: 1958-05-04
D: 2019-01-18
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Duclos, Laurie
Virginia Bergstrom
B: 1936-10-16
D: 2019-01-17
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Bergstrom, Virginia
Robert Pelletier
B: 1933-08-03
D: 2019-01-17
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Pelletier, Robert
Roy Goldsmith
B: 1950-02-17
D: 2019-01-17
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Goldsmith, Roy
Theresa Deveau
B: 1926-04-22
D: 2019-01-16
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Deveau, Theresa
Elias Zovas
B: 1924-05-20
D: 2019-01-16
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Zovas, Elias
Marion Richard
B: 1944-01-14
D: 2019-01-16
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Richard, Marion
Robert Carlson
B: 1943-03-17
D: 2019-01-16
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Carlson, Robert
Robert Guilmette
B: 1925-05-08
D: 2019-01-15
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Guilmette, Robert
Mildred Gerich
B: 1927-03-15
D: 2019-01-13
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Gerich, Mildred
Phyllis Werner
B: 1931-05-19
D: 2019-01-13
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Werner, Phyllis
Rosemary Hetzer
B: 1930-01-06
D: 2019-01-13
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Hetzer, Rosemary
Joseph Cimino
B: 1958-11-30
D: 2019-01-12
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Cimino, Joseph
Lillian Zaccaro
B: 1928-04-08
D: 2019-01-12
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Zaccaro, Lillian
Thomas Cuscovitch
B: 1939-08-02
D: 2019-01-12
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Cuscovitch, Thomas
Margaret Daviduke
B: 1923-11-12
D: 2019-01-11
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Daviduke, Margaret
Sue Justice
B: 1946-06-24
D: 2019-01-11
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Justice, Sue
Sophie Kuchy
B: 1922-10-11
D: 2019-01-10
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Kuchy, Sophie
Thomas McGraw
B: 1935-10-03
D: 2019-01-09
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McGraw, Thomas
Sara Weidner
B: 1996-05-08
D: 2019-01-07
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Weidner, Sara
Robert Jute
B: 1952-04-11
D: 2019-01-07
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Jute, Robert

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Phone: 860-749-2244
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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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Please place my information on file


 

 

 

 

 

 

 

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