Name: First:
Middle:
Last:
Residence:
Phone:
Sex:
Color:
Single:
Married:
Widowed:
Divorced:
Husband of (Maiden Name):
Wife of:
Life Partner of:
History of Residence:
Birthplace of Deceased - City:
Date of Birth:
Month:
Day:
Year:
Age:
Years:
Months:
Days:
If Veteran, specify War & Company:
Occupation:
Social Security:
Will Request Later
Kind of Business:
Company:
Years Employed:
Retired:
Education Level:
Informant:
Phone:
Informant's Address:
Father's Name:
Father's Birthplace:
Mother's Maiden Name:
Mother's Birthplace:
Cemetery/Crematory:
City or Town:
Funeral at:
Date:
Hour:
A.M. - P.M.
Calling Hours:
Military Service
Entering Date:
Discharge Date:
Service Number:
Rank, Rating:
Organization/Outfit:
Surviving Relatives and Addresses
Father:
Mother:
Husband:
Wife:
Sons:
Daughters:
Brothers:
Sisters:
Grandchildren (No.):
Great Grandchildren (No.):
Newspapers:
Milford Daily
WMRC
Middlesex
Worcester Telegram & Gazette
Woonsocket Call
Blackstone Valley Tribune
Boston Herald
Boston Globe
Other:
Picture for Newspaper
Memorial Donations:
Predeceased Family Members To Mention For Newspapers
Predeceased Names:
Service Details
Clergyman:
Call for:
Church:
Bearers:
Education:
Wedding Anniversary:
Orders & Societies:
Music:
Cemetery Information
Grave No.:
Plot No.:
Range No.:
Section No.:
Lot Owner:
Buma Funeral Home • 480 Church Street • Whitinsville, Massachusetts 01588 • 508-234-2362 • fax: 508-473-0726
Buma-Sargeant Funeral Home • 42 Congress Street • Milford, Massachusetts 01757 • 508-473-5511 • fax: 508-473-0726
Buma Funeral Home • 101 North Main Street • Uxbridge, Massachusetts 01569 • 508-278-2755 • fax: 508-473-0726
