Holt-Woodbury
Funeral Homes
& Cremation Service
|
Prearrangement Online Form |
The following is
a pre-arrangement form that you may fill out and submit online. Please be
advised that a follow up appointment with the Funeral Home Director will be
needed to finalize the pre-arrangement process. Please provide as much
information as possible. At the time of your appointment you will be asked for
your social security number and if you are a veteran of the United State
Military, you will be asked to bring a copy of your military discharge papers
to make a copy for the pre-arrangement file.
| |
PREARRANGEMENT
INDIVIDUAL INFORMATION
|
|
First Name,
Middle Name, Last Name
Street Address
City, State, Zip
MALE
FEMALE
RACE
MARITAL STATUS
BIRTHPLACE
City and State
DATE OF BIRTH
MM/DD/YEAR
OCCUPATION
EMPLOYER
VETERAN
Check Box if yes
IF YES, BRANCH
OF SERVICE
DATE ENTERED
IN SERVICE
(MM/DD/YEAR)
DATE DISCHARGED
(MM/DD/YEAR)
MILITARY RANK
SERVICE NUMBER
HIGHEST LEVEL
EDUCATION
RELIGION
CHURCH
LIST CLUBS,
NOTEWORTHY ACHIEVEMENTS, ECT.
FATHER:
Full Name/City State
MOTHER:
Full Name/City State
SPOUSE:
Full Name/City State
SON:
Full Name/City State
SON:
Full Name/City State
SON:
Full Name/City State
SON:
Full Name/City State
DAUGHTER:
Full Name/City State
DAUGHTER:
Full Name/City State
DAUGHTER:
Full Name/City State
DAUGHTER:
Full Name/City State
BROTHER:
Full Name/City State
BROTHER:
Full Name/City State
BROTHER:
Full Name/City State
BROTHER:
Full Name/City State
SISTER:
Full Name/City State
SISTER:
Full Name/City State
SISTER:
Full Name/City State
SISTER:
Full Name/City State
NUMBER
OF GRANDCHILDREN
NUMBER OF GREAT-GRANDCHILDREN
HOLT-WOODBURY
LOCATION
HENNIKER
HILLSBORO
PETERBOROUGH
CHECK ALL THAT APPLY
BURIAL
ENTOMBMENT
CREMATION
GRAVESIDE
MEMORIAL
CHURCH
OTHER
LOCATION OF SERVICE:
CLERGY:
MUSIC:
PALLBEARERS:
VIEWING:
ROSARY/WAKE SERVICE:
IN LIEU OF FLOWERS:
CEMETERY/CREMATORY:
CITY:
COUNTY:
STATE:
GRAVE NO:
LOT:
SECTION:
LOT OWNER:
IF CREMATION DISPOSITION OF ASHES:
OBITUARY NOTICES
(CHECK THE BOX NEXT TO THE PAPERS YOU WISH TO SUBMIT THE
OBITUARY FOR PUBLISHING)
CONCORD
MONITOR
UNION
LEADER
MESSENGER
VILLAGER
CONTENDER
MONADNOCK
LEDGER
KEENE SENTINEL
NASHUA
TELEGRAPH (NASHUA ,NH)
ARGUS
CHAMPION (NEWPORT ,NH)
OTHER
NEWSPAPER
NUMBER OF CERTIFIED DEATH
CERTIFICATE COPIES
ATTORNEY’S NAME
EXECUTOR
OTHER INFORMATION OR REQUESTS:
INFORMANT/CONTACT
INFORMATION
First Name,
Middle Name, Last Name
Street Address
City, State, Zip
Telephone
Number
E-Mail Address
If you desire, you
can print this form prior to pressing the submit button. After pressing
submit, the information you
submitted will pop up on
the screen (in database format) and will also be emailed to our office. You
may also print the
pop up screen.