Hillside Funeral Services Ltd.

hillside_header.gif

Section 1: Personal Information
Full Name: *
Address: *
Email: *
Phone Number: *
Date of Birth: *
Place of Birth: *
Type of Work Done:
Religion/Church:
Family Names:	Father:
	Father's Birthplace:
	Mother:
	Mother's Birthplace:
Family Members:	Brothers:
	Sisters
	Spouse:
	Children:
	Grandchildren:
Clubs/Organizations Involved In:

Section 2: Funeral Arrangements
Visitation?:	Yes No Undecided
Casket Open?:	Yes No Undecided
Funeral?:	Yes No Undecided
Location/Time:
Clergy:
Music:
Clothing:
Pallbearers:
Disposition: Is the plot already purchased?	Yes No
Burial?:	Yes No Undecided
Name of Cemetery:
Cremation?:	Yes No Undecided
Inter Ashes/ Name of Cemetery:
Family to arrange disposition of ashes:
Newspaper:
Reception at Funeral Home?:	Yes No Undecided
Reception at Church?:	Yes No Undecided
Should cremation be the desired method of disposition:
Do you wish for a memorial service?:	Yes No Undecided
Do you wish for a funeral service?:	Yes No Undecided
Location?:
Would you prefer the remains be transferred to an urn?:	Yes No Undecided
If yes, what type?:

Section 3: Next of Kin Information
Name:
Relation:
Address:
Phone Number:
Do you have a will?:	Yes No
Name of Executor(rix):
Address:
Confirmation code:
Enter confirmation code: *