Obituaries

Barbara McDonald
B: 1937-09-02
D: 2017-12-12
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McDonald, Barbara
Alton Chadwick
B: 1933-07-26
D: 2017-12-11
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Chadwick, Alton
Pamela Hoffmann
B: 1950-12-19
D: 2017-12-11
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Hoffmann, Pamela
Ruth Hilt
B: 1947-04-30
D: 2017-12-10
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Hilt, Ruth
Beulah Mackie
B: 1937-08-28
D: 2017-12-09
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Mackie, Beulah
David Bartosik
B: 1953-02-27
D: 2017-12-09
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Bartosik, David
Ralph Cline
B: 1934-04-18
D: 2017-12-06
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Cline, Ralph
Janette Sulides
B: 1931-11-08
D: 2017-12-06
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Sulides, Janette
George Marks
B: 1941-11-24
D: 2017-12-05
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Marks, George
Donald Stevens
B: 1957-02-11
D: 2017-12-04
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Stevens, Donald
Priscilla Myers
B: 1930-11-06
D: 2017-11-30
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Myers, Priscilla
Emily Ronalds
B: 1920-09-09
D: 2017-11-30
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Ronalds, Emily
Donald Hunt
B: 1931-12-15
D: 2017-11-28
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Hunt, Donald
Gail Richards
B: 1936-07-24
D: 2017-11-26
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Richards, Gail
Paul Lash
B: 1923-06-04
D: 2017-11-25
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Lash, Paul
Mary Tucker
B: 1964-09-18
D: 2017-11-25
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Tucker, Mary
Jeremy Maxwell
B: 1930-09-25
D: 2017-11-21
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Maxwell, Jeremy
Katherine Geary
B: 1950-06-25
D: 2017-11-18
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Geary, Katherine
Adam Purington
B: 1980-06-17
D: 2017-11-18
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Purington, Adam
Herbert Haynes
B: 1936-03-27
D: 2017-11-17
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Haynes, Herbert
Joan Powell
B: 1928-08-20
D: 2017-11-10
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Powell, Joan

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Bereavement Support Group

For anyone coping with the loss of a loved one. First Wednesdays, Monthly, 3:00pm - 4:30pm. Picker Family Resource Center, Rockport.

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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:
Please select Grade/Years of Education completed:
   
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:

Miscellaneous Notes and Instructions:

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