Burial Service Arrangments
by Roseberry's Funeral Home
Name
for the person the arrangement are for
First Name
Middle Name
Last Name
Disposition and Service Preferences
Type of Dispostion
Burial
Entombment
Type of Service
Viewing in Casket (requires embalming)
Graveside (requires embalming)
Immediate Burial (No Embalming) with graveside service
No service
Do you want an obituary
Yes
No
if you want an obituary - you can add it (a saved word document) to this submission. Otherwise you can email it to fd@roseberrys.com later.
Time of Service
Day - Date of Service
Place of Service
Minister
Visitation
None
One Hour Prior to service
Residence
Home address for person the plan is for
Street Address
City, Village or Township
The actual physical municipality lived in... not your mailing city
County
State
Zip Code
Back Ground Informaton
Birth Date
Birth City
Birth State
Education
8th Grade or less
9th - 12th grade, no diploma
High School graduate or GED
Some college, but no degree
Associate degree
Bachelor's degree
Master's degree
Doctorate or Professional degree
Unknown
SS#
Name of Spouse
If wife, use maiden name
Marriage Date
Marital Status
Please Select
Married
Divorced
Never Married
Widowed
Occupation
job title
Industry
Do Not enter a company's name - provide industry
Father's First Name
Fatherś Middle Name
Fatherś Last Name
Mother's First Name
Motherś Middle Name
Motherś Last Name
use maiden name
Hispanic/Spanish/Latino Origin?
No Hispanic,Spanish, Latina(o)
Mexican, Mexican American/Chicana
Puerto Rican
Unknown
Cuban
Other
Race
White
Black or Africian American
American Indian or Alaskan Native
Asian Indian
Chinese
Filipino
Japanese
Korean
Hmong
Naive Hawaiian
Other
Cemetery
Cemetery
City
County
State
Gravespace
Have gravesite
Do not have gravesite
Momument
Have monument -- please arrange for Marshfield Monument to cut last date
Have monument - will take care of getting last date cut myself
Need to get a monument
Veteran Information
Veteran?
Please Select
Select One
Yes
No
Branch of Service
Military Honors
Yes
No
War
VA Marker
Flat Bronze
Upright Granite
Type option 3
Type option 4
Next of Kin (person making arrangements)
First Name
Middle Name
Last Name
Mailing Address
City
State
Zip
Phone
Email
Number of Certified Copies:
Obituary Notes
Upload Obituary and Photo
Browse Files
Cancel
of
List Newspapers to run obituary in
Submit
Should be Empty: