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Work & Education


              Occupation:

                   Kind of                              Company
                 Business:                                 Name:






              Funeral Service Information


              Place of Service: Church           Cemetery            Other

            I prefer the Funeral Service to be: Public          Private

              Viewing for Family: Yes          No    Viewing for Friends:Yes          No


           Religious Denomination:

                  Place of Worship:


                    Lodge or Union:





             Disposition Information


                  I Prefer: Burial            Cremation            Entombment

                Cemetery:                                    Phone:

                 Address:


                I have Prearranged my
                                      Yes          No
             Cemetery Arrangements:








           Hoskins Funeral Homes and Crematorium                                  Page 37
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