Schlossberg and Solomon Memorial Chapel
824 Washington Street, Canton, MA 02021
Phone: (781) 828-6990 * (617) 739-3800 * (800) 828-6993 * Fax: 781-828-5039
E-mail: info@schlossbergchapel.com

MAKE IT EASIER for those you love

Please complete the form, below and click the "submit" button to email the information to us. We will maintain a copy of your confidential pre-arrangements in our files, and will provide a copy to you for your records.

This form is secure and cannot be read by other people on the Internet. Schlossberg Chapel will only use your information for the xpress purpose contaned in this form.

After you complete the form, click here if you would like a printed copy

Personal Information

Name of Person For Whom Funeral is Being Arranged:
Telephone Number:
Address:
 
Town/City:
County:
State:
Zip Code:
Date of Birth:
Place of Birth:
(City & State or County & State)
Marital Status:
Last Spouse's Name:
(Maiden name of wife, or husbands full name)
Education: (Highest Grade Completed)  
Secondary School: (0 - 12)
College: (1 - 4, 5+)
Occupation: (for longest period during working life)
Industry / Business
Social Security Number:
Father's Full Name:
Father's Place of Birth: (State or Country)
Mother's Full Name: (include her maiden name)
Mother's Place of Birth: (State or Country)

Person who will be in charge of funeral arrangements:

Relationship:
Name:
Address:
Town/City:
State:
Zip Code:
Telephone Number:
E-mail Address:

Military Information

Branch of Service:
Description of Service:
(Wars or conflicts fought in)
Veteran's Service Number:
Rank:
Location of Discharge Papers:

Family Members
Sons & Daughters:
(and Hometowns)
Grandchildren and Great-Grandchildren:
(First names only, unless married)
Sisters & brothers-including late:
(Hometowns)

My Funeral Service Preferences

Place of Service:
(Funeral Home, Synagogue/Temple, Graveside, or other)
Synagogue/Temple Name:
Type of Interment: Burial Cremation
Cemetery Property Owned? Yes No
If Owned - Name of Cemetery:
City, & State)
Section: Lot: Row: Space:
Memorial Contributions / Donations:
Any information or special instructions or wishes not previously listed: