On-Line Arrangements


I am planning for:

Contact email address:

General Information
Full Name:
Address:
City: Social Security # :
State:
Birth Information
Date of Birth: Father's Name:
Place of Birth: Mother's Maiden Name:
Marriage Information
Marital Status: Name of Spouse:
Place Married: Date Married:
If spouse deceased, year:
Employment Information
Employment Status: Occupation:
Employer: Number of Years:
Schooling
Please list schools attended from grade school, trade, college, etc.
Total Number of Years:
Community Involvment
Church Affiliation:
Service Organizations:
Awards, Politics, Etc.:
Survivors
Please list the names, cities and states of the following:
Spouse:
Children:
GrandChildren:
Siblings:
Parents:
Nieces/Nephews:
Other:
Service Information
Visiting Hours:
Organization Services:
Funeral Service Location:
Date and Time of Funeral:
Clergy Person
Place of Burial:
In lieu of flowers, memorial contributions may be made to:
Additional Service Information:
Special Music:
Special Readings:
Pallbearers:
Other Information or Instructions:
Veterans Information:
Branch of Service: Date and place of entry:
War: Date and place of exit:
Honors / Commendations:

 


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Nelson-Boylan-LeRette Funeral Chapel, Inc.
410 Sixth Street
Red Oak, Iowa 51566
Phone: (712) 623-2525 or
(800) 653-4881
lerette@nblfuneralchapel.com