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Brown Funeral Home
306 Spring St.
Milltown,
IN
47145
Tel: 1-812-633-4265
Personal Information
Full Name
Address
City
State
ZIP
Phone
Email
Date of Birth
Place of Birth
SSN #:
Father's name
Father's Place of Birth
Mother's name
Mother's Place of Birth
Mother's maiden name
Marital Status
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Never Married
Divorced
Widow
Widower
Spouse's Name
Spouse's Maiden Name
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Date of Marriage
Additional Family Members
Please use the area below to enter the names of siblings, children and grandchildren
Work/Education History
Education Level
Grade School
High School
Degree
Masters Degree
Doctorate
Occupation
Company Name
Business Field
Military Record
Did you serve in the military?
Yes
No
Branch of Service
Serial Number
Date entered service
Rank at Discharge
Date Discharged
Discharge on file at
Do you have a copy of your discharge papers?
Yes
No
Wars fought in
Person in charge
Address
Telephone
Funeral Service Request
Place of Service
Funeral Home
Church
Cemetery
Place of Visitation
Religious Denomination
Place of worship
Lodge/Union/Assoc. Membership
Person in charge of final arrangements
Disposition Request
I Prefer
Earth Burial
Mausoleum
Cremation
Other
Cemetery
Details (if applicable)
Lot #
Section/letter
Grave #
Address
Telephone
I have made a last will and testament
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No
Location of Will
Summary Details
Additional instructions for us
Memorial requests or donations to charity
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