Pre-Arrange Online

Name:

Gender:

Date of Birth:

Birthplace:

Residence Address:

City:

State:

Military Service #:

ZipCode:

Social Security Number:

U.S. Armed Forces:

Military Branch:

Military Dates:

Military Rank:

Wars:

Marital Status:

Date/Place of Marriage:

Surviving Spouse:

Father's Name:

Father's Birthplace:

Mother's Name:

Mother's Birthplace:

Highest Education Level:

Schools Attended:

Usual Occupation:

Kind of Business/Industry:

Employer:

Race:

Race Other:

Hispanic/Latin Origin:

If Yes, Specify:

Informant's Name:

Relationship:

Informant Address:

City:

State:

ZipCode:

Phone:

Email:

Funeral Service Preference Information:

If Other, Specify:

Do you want visiting hour (wake)?

If Yes, How Many Hour?

If casketed visiting hours, would you like to be embalmed ( required by law for public viewing)?

Where do you want the service to be held?

Name Location:

Name of Clergyperson (or denomination) to officiate:

Do you already have a cemetery lot?

Owner of Lot:

Military Honors:

Firing Detail:

Preferred Charitable Contributions:

Religion Affiliation, Fraternal Organizations, Other Organizations/Clubs:

Hobbies, Special Interests, Awards:

Predeceased by:

Survived by:

Special Instructions on Service Arrangements:

(603) 883-3401

Davis Funeral Home, LLC

1 Lock Street Nashua, NH 03064

Fax: (603) 881-3124

info@davisfuneralhomenh.com