Name of Deceased (or Person with Future Need) *

First Name

Last Name

Gender *

Male

Female

Marital Status *

Never Married

Married

Divorced

Widowed

Highest Level of Education Completed *

Grade 1-8

Grade 9/12 No Diploma

High School Graduate / GED

Trade School / Certificate

Some College Credit, No Degree

Associates Degree

Bachelors Degree

Masters Degree

Doctorate / Professional Degree

Unknown

Military Service *

Yes

No

Next of Kin Phone *

(###)

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Thoughts on Type of Service Desired

Select which one is closest to what you may be thinking. Together we can tailor the service plans to specifically suit your wishes.

Discounted Viewing and Visitation Package M-F between 11 a.m. and 3 p.m. $3795 +casket and third party charges

Discounted Visitation with Urn Package M-F between 11 a.m. and 3 p.m. $3215 +urn and third party charges

Simple, Dignified, No Services Cremation $2595 complete (optional newspapers and certified copies additional)

Full Traditional Service: 3-4 Hour Visitation and Viewing, return to funeral home the next day, proceed to church, then to cemetery or crematory. $5950+casket and third party charges

Full Traditional Service All One Day: 1-2 Hour Visitation Prior to Church or Cemetery - procession to Church then Burial at Cemetery or to Crematory $5550 +casket and third party charges

Visitation and Viewing Followed by Cremation (No Mass or Burial) $4500 +casket and third party charges

Cremation then Visitation with Service in Funeral Home or Outside Facility or Church with Urn Present $3860 +urn and third party charges

Meet Closed Casket at Church and Proceed to Cemetery After Church or to Crematory $4750 +casket and third party charges

Burial of Casket at Cemetery with Graveside Service $3635 +casket and third party charges

Cremation then Burial of Urn at Cemetery with Graveside Service $3095 +urn and third party charges

Simple, Dignified Unattended Urn or Casket Burial $2595 +casket or urn and third party charges

Digital Signature *

First Name

Last Name

Next of Kin or Statement of Authorization *

I certify and represent that I have the right to make arrangements for the above named and am not aware of any living person who has a superior right or any next-of-kin or legal authority that have an objection to make any funeral arrangements.

Today's Date *

MM

DD

YYYY

, Deceased's name. *

First Name

Last Name

I am attaching my electronic signature here: *

First Name

Last Name

My Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

My Phone: *

(###)

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By clicking this box I hereby authorize Eric Berube, director of Berube & Sons Funeral Home, specifically and solely to sign my name for me for the purpose of releasing the body of the above named deceased to the Berube & Sons Funeral Home. *

I authorize Eric Berube to sign my name in the event an actual signed copy of this form is required to release the above named decedent.

Today's Date *

MM

DD

YYYY

I, (your name) *

First Name

Last Name

Hereby claim that I am the legal next of kin to the deceased: (name of deceased) *

First Name

Last Name

The deceased *

Does have a pacemaker

Does not have a pacemaker

My attached electronic signature releases the Berube & Sons Funeral Home, its agents, and Harmony Grove Crematory of all liability regarding the knowledge of the existence of any spouse, child, parent, or any other relative that may otherwise be the legal next of kin. *

First Name

Last Name

Your Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Phone *

(###)

###

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Name of decedent or person planning a funeral ahead of time *

First Name

Last Name