Haine Funeral Home & Chapel
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Cremation - Please fill in for the lowest cost option

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DECEASED INFORMATION


Surname

Given Names
 
Maiden Name
 
Social Insurance Number


Sex     Male        Female   

Date of Birth
 
Place of Birth
 
Date of Death
POD

Approximate Weight
 lbs.
Pacemaker     Yes        No   

Address
 
City
 
Province
 
Postal Code

Phone
 


Marital Status
Date of Marriage



Fathers Name

Birthplace 

Mothers Name (Maiden)
Birthplace


Kind of Business
 
Type of Work
 


SPOUSE


Surname
 
Given Names
 
Maiden Name
 


Spouse Deceased   

Same Address   

Is There A Will     Yes        No       Unknown   
 
Executor Same As Spouse   


EXECUTOR        NEXT OF KIN   


Surname
 
Given Names
 
Address
 
City
 
Province
 
Postal Code
 
Phone Number
 
Email
 


Additional Comments




Submit


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Contact Us


905-227-1732

info@hainefuneralhome.com

26 Ormond Street South

Thorold, ON L2V1Y4

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Funeral Director

on call 24 hours

 

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License 527-Funeral Establishment Class-1

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