Obituaries

Winifred Robertson
B: 1942-11-13
D: 2017-11-17
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Robertson, Winifred
Lena Black
B: 1942-09-26
D: 2017-11-17
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Black, Lena
Kelly Christian
B: 1965-01-25
D: 2017-11-15
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Christian, Kelly
Dennis Rini
B: 1947-01-06
D: 2017-11-10
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Rini, Dennis
John Aldrich
B: 1947-10-31
D: 2017-11-10
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Aldrich, John
Sharon Lawson
B: 1949-09-09
D: 2017-11-09
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Lawson, Sharon
Richard Preston
B: 1946-10-02
D: 2017-11-08
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Preston, Richard
John Welsh
B: 1974-03-16
D: 2017-11-08
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Welsh, John
Roger Johnson
B: 1931-03-14
D: 2017-11-03
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Johnson, Roger
Larry Miller
B: 1944-07-23
D: 2017-11-01
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Miller, Larry
Jim Harmon
B: 1937-11-03
D: 2017-11-01
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Harmon, Jim
Dianna Laurendeau
B: 1958-01-27
D: 2017-10-28
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Laurendeau, Dianna
Lorie Asher
B: 1962-04-23
D: 2017-10-27
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Asher, Lorie
Linda Lust
B: 1956-04-01
D: 2017-10-27
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Lust, Linda
Dianne Graham
B: 1948-11-07
D: 2017-10-27
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Graham, Dianne
Jeremy Rhodes
B: 1984-02-02
D: 2017-10-26
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Rhodes, Jeremy
Thomas Bartruff
B: 1961-08-16
D: 2017-10-23
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Bartruff, Thomas
Lynette Scholl
B: 1953-03-27
D: 2017-10-23
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Scholl, Lynette
Linda Newman
B: 1948-02-27
D: 2017-10-22
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Newman, Linda
David Dillard
B: 1960-09-19
D: 2017-10-18
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Dillard, David
Duane Harne
B: 1966-02-19
D: 2017-10-18
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Harne, Duane

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305 N. Potomac St.
HAGERSTOWN, MD 21740
Phone: (301) 739-5498
Fax: (301) 733-6369

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If you have immediate need of our services, please feel free to use the form below to provide us as much information as you have available to save time at the arrangement conference. We understand this is a difficult time and want to make things as easy as possible. Please feel free to call us anytime at (301) 739-5498 or email us at tim.harman@potomaccremation.com and we will be happy to assist you.


I. Biographical Information
 
Full Name:
Date of Death:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number:
(xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number: For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded In Death
Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:

II. Military Record

Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. Service Preferences

Type of Service:
Visitation Hours:
Person in Charge of Arrangements:
Officiating Clergy:
Flower Preference:
Music Selection:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

Please select one of the options below:

Please send me information

Please contact me to schedule an appointment

Please place my information on file