Buma Funeral Homes - Funeral Services in Milford, Uxbridge and Whitinsville, Massachusetts

Red items needed for death certificate. Please fill in.
Name: First:		Middle:
Last:
Residence:
Phone:
Sex:		Color:
	Single Married Widowed Divorced
Husband of:	(Full Name including Maiden Name)
Wife of:
Life Partner of:
History of Residence:
Deceased's Birthplace - City:		State/Country:
Date of Birth:	Month: Day: Year: Age:
If Veteran, specify War & Company:
Occupation:
Social Security:	Will Request Later
Kind of Business:		Company:
Years Employed:		Retired:
Education Level:

Informant: (person in charge of arrangements)
Relation to deceased:
Phone (Home):		(Cell):
Informant's Address:
Father's Name:		Father's Birthplace:
Mother's Full Name including Maiden Name:		Mother's Birthplace:
Cemetery/Crematory:
City or Town:
Funeral at:
Date:		Hour:	A.M. - P.M.
Calling Hours:
Military Service (Please bring a copy of discharge papers to arrangement conference)
Entering Date:		Discharge Date:
Service Number:		Rank, Rating:
Organization/Outfit:
Surviving Relatives and Addresses
Father's Name:		City/State:
Mother's Name:		City/State:
Husband's Name:		City/State:
Wife's Name:		City/State:
For the larger boxes below, enter one name per line and align the address with each name.
Sons - Name:		City/State:
Daughters - Name:		City/State:
Brothers - Name:		City/State:
Sisters - Name:		City/State:
Others to be mentioned in newspaper - Name:		City/State:
Grandchildren (No.):		Great G'children (No.):
Newspapers:	Check If You Have A Picture for Newspaper
	Milford Daily
	WMRC
	Metrowest Daily
	Worcester Telegram & Gazette
	Woonsocket Call
	Blackstone Valley Tribune
	Uxbridge Times
	Boston Herald
	Boston Globe
	Other:
Memorial Donations:
Service Details
Name of Clergy:		Phone #:
Church:
Bearers:
Education:
Wedding Anniversary:
Orders/Societies/ Hobbies/Interests:
Music: (For funeral service and visiting hours)
Cemetery Information
Cemetery Name:
Grave No.:		Plot No.:
Range No.:		Section No.:
Lot Owner:

06/19/2013 2:34am

Milford Weather Forecast, MA

Buma Funeral Home � 480 Church Street � Whitinsville, Massachusetts 01588 � 508-234-2362 � fax: 508-473-0726

Buma-Sargeant Funeral Home � 42 Congress Street � Milford, Massachusetts 01757 � 508-473-5511 � fax: 508-473-0726

Buma Funeral Home � 101 North Main Street � Uxbridge, Massachusetts 01569 � 508-278-2755 � fax: 508-473-0726

Site Last Updated: June 17^th, 2013 at 3:09 PM ET

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