Page 21 - Pattison Funeral Home

Vital Statistics About me:
Name:______________________________________________________________________________ Social insurance number:________________________ Alberta health number:__________________ Date of birth:____________________________ Place of birth:________________________________ (Birth certificate kept in ______________________________________________________________) Occupation (Most of your working life) _________________________________________________ Business or industry: _________________________________________________________________ Marital status: _______________________________________________________________________ Spouse name (Include maiden name if applicable) _______________________________________ Date of marriage: ___________________ Place (City) ______________________________________ (Marriage certificate kept in __________________________________________________________) Name of church or other place ________________________________________________________ Father’s name: _____________________________ Birth place: ______________________________ Mother’s name: ____________________________ Birth place: ______________________________ Mother’s maiden name: ______________________________________________________________
Funeral Service Instructions:
The funeral home where I have my instructions (or the funeral home of my choice) is the Pattison Funeral Home, Medicine Hat, Alberta 403-526-2214 – 540 South Railway Street SE, Medicine Hat, Alberta.
Place for Funeral to Take Place:
My church: (Name) ___________________________________________________________ Pattison Chapel
Other location: (Name) _______________________________________________________
Pattison Funeral Home - Page 21