Biographical Record Form
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BIOGRAPHICAL INFORMATION REQUIRED
First Name
Middle Name
Last Name
Maiden Name
Social Security Number
Residence Address
Years Residing
City
State
Zip
Mailing Address
City
State
Zip
Town of Former Residence
Years Residing
Date of Birth
Birthplace
Name of Father
Father's Birthplace
Name of Mother (include maiden name)
Mother's Birthplace
Ethnic Origin
Hispanic
Yes
No
Race
Marital Status
married
widowed
never married
divorced
Spouse's Name
(include maiden name)
USUAL OCCUPATION
Give kind of work done during most of working life. DO NOT use retired
Occupation
Employer
Years Employed
Other Places of Employment you may want included in newspaper notice
SURVIVORS
NAME
RELATIONSHIP
CITY & STATE OF RESIDENCE
PREDECEASED FAMILY MEMBERS - Name only required
Education
Clubs/Organizations/Hobbies
VETERAN'S SERVICE RECORD
Veteran's service information can be obtained from the DD 214 (Discharge Papers). A DD 214 is a REQUIRED document for ANY military honors or burial.
Date & Place entered Service
Date & Place Discharged
Branch of Service
Rank at time of Discharge
Service Serial Number or Claim Number
CEMETERY INFORMATION
Cemetery Name
Lot
Section Number
Date of Last Interment in Lot
CHURCH & CLERGY NAME INFORMATION
Church
Clergy Name
Memorial Contributions Required
Yes
No
Name of Charity Organization
Address
City
State
Zip
CLOTHING
We always suggest a long sleeve dress with a modest neckline for the women and a suit for the man. Possibly something that they would wear to church or out to dinner. It should reflect needs of the individual. Please provide undergarments when possible. Shoes may be worn if desired but are not necessary.
PICTURE
A picture can be used in the newspaper with the obituary or it may be used for the hairdresser to reference
Sender's Name
Sender's e-mail
Sender's contact #
Route 44 at Greenville Common . Greenville, RI 02828 . (401) 949-0180 .
awfh@aol.com
© 2012 Anderson Winfield Funeral Home. All Rights Reserved.
Biographical Record Form
