Page 23 - C.H. Boudreau Funeral Home Limited

Information for newspapers - a guideline:
Place of Death:
Favourite poem, verse or scripture:
Some significant accomplishments in my life: One of my fondest memories:
One of the greatest inspirations in my life:
If I could live my life over again, I would change: Favourite Places:
Favourite colour, flower, food etc.:
I want my family to remember me for:
A message to my family and friends:
Special Notes:
Information Required for CPP Benefits and Legal Documents
Is there a Will: Yes No Who is the Executoe/Executrix:
Full Address:
City: Province: Tel:
Postal Code:
Email:
Cell:
Did you ever work in another country: Yes No Where: Have you ever received or Applied for benefits?
Your SIN #:
CPP Old Age Quebec Disability
C.H. Boudreau Funeral Home Limited - Page 23