Burket-Truby Funeral Home of Oakmont Burket-Truby Funeral Home of Oakmont Burket-Truby Funeral Home of Oakmont
  Burket-Truby Funeral Home of Oakmont Burket-Truby Funeral Home of Oakmont
 

Burket-Truby Funeral Home of Oakmont
Personal Information and Family Instructions
Full Name:   Nick Name:
Address:
City:   State:   Zip Code:   County:
Phone:     Email:
Date of Birth:     Place of Birth:
Social Security #:
Father's Name:     Living   Deceased:
Mother's Name:     Living   Deceased:
Maiden Name of Mother:
Education (0-12):     Education (1-5+):
Occupation:   Status:
Employer:     City & State:
Church Membership:
Social Clubs or Activities:
Veteran Branch of Service:     Serial Number:
Date Enlisted:     Rank At Discharge:
Date Discharged:     Copy of Discharge Papers: Yes     No
If Yes, Location of Discharge Papers:
Name of Wars:
Marital Status:     Name of Spouse:
Maiden Name of Spouse:
Children (Include City/State of Residence):
Brothers/Sisters (Include City/State of Residence):
Grandchildren: Great-Grandchildren: Great-Great-Grandchildren:
Family Contact/Person in Charge:
Address:     City/State/Zip:
Phone:
Memorial Contributions:
Funeral Home:
Funeral Director:   Phone Number:
Place of Visitation:
Place of Funeral Service:
Clergyman:
I Prefer:
Cemetery:   Phone Number:
Address:   City/State/Zip:
Section:   Lot:
Block:   Grave Number(s):
I have made a last will and testament: Yes     No
Location:
Casket Preference:
Outer Burial Container/Vault Preference:

Special Instructions
Clothing: My Own     Other
Jewelry:
Glasses:
Other:
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