Personal Information

Thank you for taking the time to complete the personal information form. By completing the following information, you will have time to think about what type of service you may desire, and find it easier to provide correct information.

The information on this form will help the funeral home complete the death certificate and other required documents. In addition, it will assist in the composition of an obituary, help the funeral director better understand your initial wishes, and expedite the arrangement conference at the funeral home.

Please complete as much of the form as possible and select the Submit Information tab at the bottom of the page. This will send the information to the funeral home.

Information about the person completing this form:
Name:
Your Address/City/State:
Telephone:
e-mail Address:
I am Planning For:
Vital Information about the person you are planning for:
First Name:
Middle Name:
Last Name:
Street Address:
City/Town/Boro:
State:
Zip Code:
Length of Time Living Here:
Coming From:
Social Security Number:
Sex:
Race:
Hispanic Origin:
Martial Status:
Citizen:
Birthplace:
Date of Birth:
Father's Name:
Mother's Name:
Mother's Maiden Name:
Name of Spouse:
Maiden Name of Spouse:
Is Spouse Deceased:
If Yes, Year:
Surviving Family Members:
Please list Name, Town, State
Parents:
Spouse/Partner:
Son(s)
Daughter(s)
Brother(s)
Sister(s)
Other Relatives:
Special Friends:
Grandchildren:
Great-Grandchildren:
Military Records:
Copy of Discharge:
Branch of Service:
Name of War:
Honors Requested:
Education and Employment:
Highest Level of Education:
Occupation:
Years Employed:
Retired:
If Yes, Year:
Employer(s):
Memberships:
Clubs:
Organizations:
Achievements:
Funeral Service Details:
Disposition:
Cemetery/Mausoleum:
Deed Available:
Deed Information:
Religious Affiliation:
Name of Church:
Member:
Location of Church:
Music Selections:
Special Requests:
Rites / Visitation:
Public Visitation:
Visitation Hours:
Service will be:
Service Type:
Service at:
Casket Bearers:
Family Bearers (6):





Additional Considerations:
Memorial Donations:
Please List Charities:

Other items which may be needed or should be considered would be:
dentures, jewelry, clothing, glasses, photographs and personal memorabillia

Concierge Services

The Damiano Funeral Home offers many services that set us apart from other local funeral homes, We are available to assist you in the following areas:

Flowers, Restaurants, Transportation, Hotel Accommodations, Monuments, Engraving, Processing of insurance claims, veterans benefits and social security notifications.

Should you have any questions please contact our funeral home at any time.