At-Need Form | Brown & Hickey Funeral Home and Cremation Service Belmont MA funeral home and cremation Belmont MA funeral home and cremation

Please complete the below information for the person you are planning arrangements for:

Full Name(First, Middle, Last name)

Street

City

State/Province

ZIP/Postcode

Date of Birth

SSN #

Place of Birth(State & City or Town)

Father's Name

Mother's Name

Mother's Maiden Name

Marital Status

Father's Place of Birth

Mother's Place of Birth

Spouse's Name

Spouse's Maiden Name

Family MembersPlease use the area above to enter the names of family members (Spouse, Children, Grandchildren, Great- Grandchildren, Siblings)

History

Occupation(Cannot Be Retired)

Kind of Business/Industry(Cannot Be Retired)

Ethnicity (ex., American, Chinese, etc.)

Race(ex., White, Black, etc.)

Military Records

Did you serve in the military?

YesNo

If so, do you have a copy of your discharge papers?

YesNo

Branch of Service

Date Entered Service

Date Discharged

Serial Number

Rank at Discharge

Service Planning

Place of Service(If Applicable)

Place of Worship (If Applicable)

Place of Visitation (If Applicable)

Disposition Planning

I Prefer

Cemetery Name(If Applicable)

Lot #(If Applicable)

Section/Letter(If Applicable)

Grave #(If Applicable)

Informant (Responsible Party)

Informant Name

Informant Relationship

Street

City

State/Province

ZIP/Postcode

Informant Telephone

Informant Email Address

Summary Details

Memorial Requests or Donations To Charity(If Applicable)

Please Write In Any Additional Information That You Would Like Us To Know