Shepherd Funeral & Cremation Service, Pembroke, Kingston and Carver, MA

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Please complete the following form to begin the funeral arangement process.

**Personal Information**
Name :
Marital Status:
Date of Birth:		Place Of Birth :
Address:
City:		State:
County:		Zip:
Phone:		E-mail:
Spouse's Name:		Spouse's Maiden Name:
Place of Marriage:		Date of Marriage:
Father's Name:		Mother's Name:
Fathers Place of Birth:		Mothers Place of Birth:
Mother's Maiden Name:

Person in Charge of Final Arrangements:
Address:
Phone:

**Please List Your Family Members and Relationship**

**Work/Education History**
Education(0-12):		College 1-5+:
Occupation:
Business:		Company:
Organizations:
Memberships:
Special Intersets :

**Military Record**
Branch of Service:		Serial Number:
Date Enlisted:		Rank At Discharge:
Date Discharged:		Discharge On File At:
Copy of Discharge Papers: Yes No
Name Of Wars:

**Funeral Service Request**
Place Of Service:
Place of Visitation:
Religious Denomination:
Place Of Worship:
Lodge / Union:

**Disposition Request**
I Prefer:
Cemetery:
Address:		Phone:
Section:
I have made a last will and testament: Yes No
Location:

**Other Instructions**

**Memorials/Donations To Charity**

**Please select one of the options below**
Send information about pre-arrangement Contact me to set an appointment Please keep my information on file

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