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Online Arrangements

Your Loved One's Information

Last Name*:

First & Middle Name*:

Chosen/Preferred Name*:

Sex*:

Has a Death Occurred?*:

Date of Death (If Applicable)::

Su	Mo	Tu	We	Th	Fr	Sa
26	27	28	29	30	31	1	2	3	4	5	6	7
2	3	4	5	6	7	8	9	10	11	12	13	14
9	10	11	12	13	14	15	16	17	18	19	20	21
16	17	18	19	20	21	22	23	24	25	26	27	28
23	24	25	26	27	28	29	30	1	2	3
30				4	5	6	7	8	9	10

Where is Your Loved One Currently Resting?*:

Is there a Will?*:

Yes

If Yes, Who is the Executor?:

Mailing Information

Address*:

City*:

Country*:

State/Province*:

Zip/Postal code*:

Email Address:

Phone Number:

Date Of Birth*:

Su	Mo	Tu	We	Th	Fr	Sa
26	27	28	29	30	31	1	2	3	4	5	6	7
2	3	4	5	6	7	8	9	10	11	12	13	14
9	10	11	12	13	14	15	16	17	18	19	20	21
16	17	18	19	20	21	22	23	24	25	26	27	28
23	24	25	26	27	28	29	30	1	2	3
30				4	5	6	7	8	9	10

Place Of Birth*:

SIN:

Health Card #:

Driver's License:

Is/Was Your Loved One Status Indigenous, Metis or Inuit?*:

Yes

If Yes, Which Nation are They a Member of?:

Occupation:

Industry:

Marital Status*:

Spouses Name (Maiden):

Father's Name:

Father's Place of Birth (City and Province/Country):

Mother's Name:

Mother's Maiden Name:

Mother's Place of Birth (City and Province/Country):

Legal Next of Kin / Executor

Funeral Service Information

Place of Service:

I Prefer the Funeral Service To Be:

Viewing for Family:

Yes

Viewing for Friends:

Yes

Religious Denomination:

Place or Worship:

Lodge or Union:

Disposition Information

I Prefer:

Cemetery:

Address:

Phone:

I Have Made A Last Will & Testament:

Yes

Special Instructions

Robert Anderson
Funeral Services, Inc.

115-190 MacAlpine Crescent
Fort McMurray, AB

T9H 4A6

P: (780) 790-1220
F: (780) 790-9199

rafser@telus.net

Su	Mo	Tu	We	Th	Fr	Sa
						1	2	3	4	5	6	7
2	3	4	5	6	7	8	9	10	11	12	13	14
9	10	11	12	13	14	15	16	17	18	19	20	21
16	17	18	19	20	21	22	23	24	25	26	27	28
23	24	25	26	27	28	29	30
30

Su	Mo	Tu	We	Th	Fr	Sa
						1	2	3	4	5	6	7
2	3	4	5	6	7	8	9	10	11	12	13	14
9	10	11	12	13	14	15	16	17	18	19	20	21
16	17	18	19	20	21	22	23	24	25	26	27	28
23	24	25	26	27	28	29	30
30

Su	Mo	Tu	We	Th	Fr	Sa
						1	2	3	4	5	6	7
2	3	4	5	6	7	8	9	10	11	12	13	14
9	10	11	12	13	14	15	16	17	18	19	20	21
16	17	18	19	20	21	22	23	24	25	26	27	28
23	24	25	26	27	28	29	30
30

Su	Mo	Tu	We	Th	Fr	Sa
						1	2	3	4	5	6	7
2	3	4	5	6	7	8	9	10	11	12	13	14
9	10	11	12	13	14	15	16	17	18	19	20	21
16	17	18	19	20	21	22	23	24	25	26	27	28
23	24	25	26	27	28	29	30
30

Online Arrangements