Pre-arrangement Information Form

Address: 63 Chestnut Hill Avenue, Brighton, MA, 02135, US
Telephone: (617) 782-9636

Use this form to provide us with as much or as little detail as you wish. At a minimum, provide us with your name and telephone number and tell us how you'd like us to work with you on the remaining information using the options at the base of the form.
Personal Information
Full Name*
First Middle Last
Address*
Street City State Zip/Postcode

Do not use P.O. box.
Telephone*
Email Address*
Date of Birth*
MM slash DD slash YYYY
Place of Birth*
SSN #*
Father's Name*
Father's Place of Birth*
Mother's Name*
Mother's Place of Birth*
Mother's Maiden Name*
Marital Status*
Spouse's Name*
Spouse's Maiden Name*
Place of Marriage*
Date of Marriage
MM slash DD slash YYYY
Additional Family Members
Please use the area above to enter the names of siblings, children and grandchildren.
Work/Education History
Education Level
- Grade School
- High School
- Degree
- Masters Degree
- Doctorate
- Unknown
Occupation*
Company Name*
Business Field*
Military Record
Did you serve in the military?*
- Yes
- No
- Unknown
Branch of Service*
Serial Number
Date Entered Service
Rank at Discharge
Date Discharged
Discharge on file at
Do you have a copy of your discharge papers?
- Yes
- No
Wars Fought In
Person in Charge
Address
Telephone
Funeral Service Request
Place of Service*
Telephone
Place of Visitation
Religious Denomination
Place of Worship
Lodge/Union/Assoc. Membership
Person in charge of final arrangements
Disposition Request
I Prefer
Cemetery
Lot #

(if applicable)
Section/Letter

(if applicable)
Grave #

(if applicable)
Address
Telephone
I have made a last will and testament
- Yes
- No
Location of Will
Summary Details
Additional instructions for us
Memorial requests or donations to charity
Please select from one of the options below:*
- Send me information about pre-arrangements
- Contact me to set up an appointment
- No appointment needed: just keep my request and information on file
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Email*
Question*
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Contact Us

Lehman, Reen, McNamara Funeral Home
63 Chestnut Hill Ave, Brighton, MA 02135
(617) 782-9636
lrmfuneralhome@gmail.com

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Personal Information

Work/Education History

Military Record

Funeral Service Request

Disposition Request

Summary Details

Contact Us

Local Area Weather

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No Hidden Fees