Contact Us / Location
330-18th Street North
Brandon, MB R7A 7P3
Phone: 204-727-0330
Fax: 204-725-0971

Immediate Need


I. Biographical Information
 
Full Name:
Date of Death:
Address1:
Address2:
City Name:
Province/Territory:
Postal Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
Province/Territory of Birth:
Social Insurance Number:
Father's Name:
Father's Place of Birth:
Mother's Name:
Mother's Place of Birth:
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:

II. Military Record

Veteran:
Branch of Service:
Regimental Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Time of Military Service:

III. Service Preferences

Type of Service:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Disposition:
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

This form does not have to be completed in its entirety.  Your funeral director will assist you and answer any questions you may have.  please call 204-727-0330 for immediate assistance.

 

 

 

 

 

 

 

 

 

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