Notoriety (membership in clubs, organizations, offices held, etc..)
List other family members (if deceased indicate date of death in city state block)
Relationship, First name, MI, last name, Marital status, Spouse 1st Name, City State Zip
Other Family Information
Funeral Instructions
The following information is for guidance at the time of my death. It is intended to assist those handling my personal affairs. I have expressed my preference on certain subjects which, unless changed by unexpected circumstances, I hereby desire and request:
1. I wish my services to be held at
2. I would prefer as clergman
3. I have viewed caskets and would prefer
4. I prefer as an outer burial vault
5. I prefer:
Burial
entombment
Cremation
6. I prefer:
Public viewing
Family viewing
Church service
No service
7. My executor/executrix is:
*
8. My attorney is:
*
9. Other instructions:
Funeral Instruction of
Name
:
*
Date
:
*
Joseph V. Leahy Funeral Home, Inc
27 Smith Avenue
Kingston New York 12401
845 331-3272
