Obituaries

Burnestine Ofoegbu
B: 1951-12-23
D: 2017-08-15
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Ofoegbu, Burnestine
Vincent Keller
B: 1963-11-19
D: 2017-08-12
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Keller, Vincent
Chester Zarubnicky
B: 1932-12-17
D: 2017-08-12
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Zarubnicky, Chester
Pauline Kresge
B: 1927-05-31
D: 2017-08-08
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Kresge, Pauline
Richard Gouveia
B: 1941-07-06
D: 2017-08-08
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Gouveia, Richard
Jan Fatylak
B: 1952-06-22
D: 2017-08-07
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Fatylak, Jan
Peter Burke
B: 1937-01-03
D: 2017-08-02
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Burke, Peter
Neville Parnell
B: 1940-09-12
D: 2017-07-24
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Parnell, Neville
Jose Betancourt
B: 1972-03-26
D: 2017-07-21
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Betancourt, Jose
Robert Smith
B: 1956-01-23
D: 2017-07-16
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Smith, Robert
Nicholas Tilwick
B: 1986-12-04
D: 2017-07-15
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Tilwick, Nicholas
Alice Gilbert
B: 1924-02-08
D: 2017-07-14
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Gilbert, Alice
Steven Felder
B: 1956-07-01
D: 2017-07-09
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Felder, Steven
Lee Bond
B: 1926-02-04
D: 2017-07-07
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Bond, Lee
Norma Pudleiner
B: 1929-10-19
D: 2017-07-06
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Pudleiner, Norma
Carl Dalrymple
B: 1935-10-17
D: 2017-07-06
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Dalrymple, Carl
Paul Reinacher
B: 1939-12-11
D: 2017-07-02
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Reinacher, Paul
Edith Fuqua
B: 1932-08-07
D: 2017-06-28
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Fuqua, Edith
Patrick Williams
B: 1950-01-11
D: 2017-06-24
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Williams, Patrick
Shirley Mosluk
B: 1949-05-10
D: 2017-06-17
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Mosluk, Shirley
Isabell Brong
B: 1925-11-11
D: 2017-06-14
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Brong, Isabell

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1763 Route 209
P.O. Box 25
Brodheadsville, PA 18322
Phone: (570) 992-4768
Fax: (570) 992-1235

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I. Biographical Information
 
Full Name:
Date of Death:
Address1:
Address2:
City Name:
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Zip Code:
Telephone Number: (xxx-xxx-xxxx)
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Date of Birth: (month/day/year)
City of Birth:
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Highest Education Level:
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Social Security Number: For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Father's Name:
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Mother's Name:
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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:
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Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

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