Obituaries

Richard Drum
B: 1928-12-17
D: 2017-07-17
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Drum, Richard
Freda Millspaugh
B: 1922-03-20
D: 2017-07-16
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Millspaugh, Freda
Donald Savey
B: 1930-11-16
D: 2017-07-11
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Savey, Donald
Jolena Gromes
B: 1979-10-07
D: 2017-07-04
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Gromes, Jolena
Michael Masin
B: 1942-07-11
D: 2017-07-03
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Masin, Michael
Salvatore Lentini
B: 1944-01-04
D: 2017-06-27
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Lentini, Salvatore
James Williams
B: 1949-04-11
D: 2017-06-23
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Williams, James
Shannon Brutcher
B: 1975-10-13
D: 2017-06-22
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Brutcher, Shannon
Rebecca Stock
B: 1922-09-04
D: 2017-06-13
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Stock, Rebecca
Nina Lencki
B: 1916-12-24
D: 2017-06-10
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Lencki, Nina
Konrad Jessup
B: 1931-09-01
D: 2017-06-06
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Jessup, Konrad
Bruce Chabot
B: 1951-01-06
D: 2017-06-06
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Chabot, Bruce
Margaret Davie
B: 1930-10-13
D: 2017-05-19
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Davie, Margaret
Howard Johnson
B: 1939-11-11
D: 2017-05-04
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Johnson, Howard
Elbert Alexander
B: 1941-06-03
D: 2017-04-30
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Alexander, Elbert
Victoria Shafer
B: 1938-02-20
D: 2017-04-26
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Shafer, Victoria
Treva West
B: 1942-11-09
D: 2017-04-21
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West, Treva
Jay Crane
B: 1947-06-24
D: 2017-04-16
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Crane, Jay
Clarisa Fife
B: 1920-03-09
D: 2017-04-15
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Fife, Clarisa
Sharon Moss
B: 1941-12-11
D: 2017-04-13
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Moss, Sharon
Dianne King
B: 1945-02-11
D: 2017-04-12
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King, Dianne

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Horseheads, NY 14845
Phone: (607) 739-2035
Fax: 607-739-2148

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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:
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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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