I would like an appointment with:
1 Lawrence Street
Spring Valley, NY
139 Stage Road
Monroe, NY
Pre-arrangements or at need arrangements to be made in the comfort of my residence or office
3 Hudson Street, Chester, NY
Time:
8:00am
9:00am
10:00am
11:00am
12:00pm
1:00pm
2:00pm
3:00pm
4:00pm
5:00pm
Day:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month:
January
February
March
April
May
June
July
August
September
October
November
December
Year:
2000
2001
2002
2003
2004
2005
Deceased First Name:
Deceased Middle Name:
Deceased Last Name:
Place of death:
Time of death:
Legal (Street) address:
City, State, Zip code:
Date of Birth:
Age:
City and State of Birth:
Social Security Number:
Veteran (bring discharge paper):
Occupation (Do not put retired):
Type of Business:
Number of years of Education:
Spouse's FirstName:
Spouse's Last Name (Maiden):
Father's First Name:
Father's Last Name:
Mother's First Name:
Mother's Last Name (Maiden):
Doctor's Name:
Doctor's Phone Number:
Last Date Seen by Doctor:
Name of Cemetery:
Street Address of Cemetery:
City, State, Zip code of Cemetery:
Person making the Arrangements:
Your relationship to the deceased:
Your Phone Number:
Suggested Hours of Visitation:
Monday through Friday within the hours of 3:00pm-8:00pm,
Sunday within the hours of 2:00pm-6:00pm
We will call you to confirm an appointment.
Email:
info@cremationmemorialcenters.com
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