Obituaries

Suzanne Jillard
B: 1932-06-21
D: 2017-06-23
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Jillard, Suzanne
Mary Leach
B: 1955-11-17
D: 2017-06-22
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Leach, Mary
Joseph Capone
B: 1935-07-23
D: 2017-06-15
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Capone, Joseph
Rita Harrison
B: 1925-05-31
D: 2017-06-11
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Harrison, Rita
Grace Karwoski
B: 1938-08-27
D: 2017-06-10
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Karwoski, Grace
Mitchell Kozak
B: 1948-08-25
D: 2017-06-08
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Kozak, Mitchell
Frederick Burns
B: 1958-09-13
D: 2017-06-05
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Burns, Frederick
Margaretta D'Antonio
B: 1935-01-31
D: 2017-05-27
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D'Antonio, Margaretta
Charles Smith
B: 1949-10-10
D: 2017-05-22
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Smith, Charles
Donald Dawson
B: 1955-05-18
D: 2017-05-19
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Dawson, Donald
Edward Rheinstadter
B: 1946-12-21
D: 2017-05-17
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Rheinstadter, Edward
Justis Greto
B: 2001-09-22
D: 2017-05-11
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Greto, Justis
Annemarie Rapp
B: 1948-08-08
D: 2017-05-07
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Rapp, Annemarie
Thomas Holmes
B: 1991-06-20
D: 2017-04-24
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Holmes, Thomas
Walter Bayliss
B: 1929-05-10
D: 2017-04-23
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Bayliss, Walter
William DiMartino
B: 1936-02-10
D: 2017-04-22
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DiMartino, William
Teresa Cornish
B: 1921-03-10
D: 2017-04-21
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Cornish, Teresa
Mary Yeager
B: 1934-12-12
D: 2017-04-17
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Yeager, Mary
Martin Lyons
B: 1927-08-21
D: 2017-04-16
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Lyons, Martin
William McGoff
B: 1935-01-02
D: 2017-04-16
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McGoff, William
Carol Ronan
B: 1930-07-09
D: 2017-04-10
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Ronan, Carol

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202 S Chester Pike
Glenolden, PA 19036
Phone: 610-583-4400
Fax: 610-583-5080

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I. Biographical Information
 
Full Name:
Date of Death:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number: For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded In Death
Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:

II. Military Record

Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. Service Preferences

Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

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