Funeral Preference Instructions

Please complete and submit the form below to securely leave your personal wishes with us.  Thank you.

Name:

Today's Date:

Current mailing address:

My preference is to be: Earth Burial Cremated Entombment Other, Specify

Interment in:CemeteryNicheScatteringMausoleumGiven to my family Name: In (City and State):

I have An existing family plot An individual plot     Section: Lot: Purchaser's name:

I prefer: an Upright Headstone Flush Granite Marker Bronze Marker No Marker Engrave existing marker   Engraving needed:

I Prefer a: Wooden Casket Metal casket Cloth Covered Casket Cremation Casket

in the following price range: Above AverageAverage Price Below Average

I desire a: Public Services or a Private Service

I desire a: Traditional Church/Temple Service or a Funeral Home Service Memorial Service(without casket or cremains present)  Graveside Service Only

I prefer Calling Hours to be: Public or Private  Number of Hours:

I desire: No Calling Hours.

The Name and Place of my Place of Worship is:

I would like these reading and/or hymns:

I prefer the following media outlet for the Obituary:

I prefer:  Flowers, Preferred Florist:

              Memorial Donations, made to:

              In Lieu of Flowers, Donations made to:

I prefer Military Honors: No Yes N/A Not a Veteran

I have my Discharge paperwork(Certificate or DD-214): No Yes

I served in the:ArmyAir ForceCoast GuardMarine CorpsNavy, During  Conflict/War.

If you have a copy of your Discharge paperwork and would like to send us a copy please email it to:

Wecare@BTMFuneralHome.com

or mail it to us at

Buckmiller Thurston Mengacci Funeral Home

P.o. Box 553, Naugatuck, Ct 06770

Additional information that I would like to add:

Would you like to receive a confirmation email or phone call? yes No

If yes, please enter your email or phone number: