Vital Statistics
We suggest completing the following record and filing a copy of this information with the Borek Jennings Funeral Home. In the event of death, this information will be extremely helpful. There is no cost involved in doing this.
Vital Statistical and Biographical Record:
Full Name:
Phone:
Address:
City:
State:
Zip:
Married:
Married:
Yes
No
Spouse:
If your spouse is female what is Maiden Name:
Date of Marriage:
Place of Marriage:
Birth Date:
Birth Place:
Ethnic Origin:
Email:
Fathers Name:
Mothers Name:
Length of Residence Here:
Education:
Occupation:
Employer:
Retirement:
SSN:
Veteran:
Yes
No
Branch:
Religious Affiliation:
Church:
Clubs and Organizations:
List of Family Members:
(Spouse, children, brothers, sisters)
Name:
Relationship
City/State
Additional Family Members:
Number of Grandchildren:
Great Grandchildren:
Number of Grandchildren:
Great Grandchildren:
Proceeded in death by:
Borek Jennings Funeral Homes & Cremation Service
Hamburg Chapel
810-231-0200 •
Lamb Chapel Howell
517-546-0100
Jenter Chapel Manchester
734-428-8250
•
Braun Chapel Brooklyn
517-592-2280
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