Obituaries

Mohan Kaur Walia
B: 1940-11-07
D: 2019-01-18
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Walia, Mohan Kaur
Radha Bhagirathee
B: 1952-06-30
D: 2019-01-18
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Bhagirathee, Radha
Barbara Taylor
B: 1940-03-28
D: 2019-01-16
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Taylor, Barbara
Devon Persaud
B: 1998-07-12
D: 2019-01-16
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Persaud, Devon
Billa Lal
B: 1989-04-14
D: 2019-01-16
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Lal, Billa
Beverly Andrea Thom
B: 1961-04-29
D: 2019-01-11
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Thom, Beverly Andrea
Dharam Dass
B: 1955-05-20
D: 2019-01-07
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Dass, Dharam
Badrinauth Bachhu
B: 1957-01-15
D: 2019-01-05
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Bachhu, Badrinauth
Marilyn Adolph-Duncan
B: 1957-04-09
D: 2019-01-02
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Adolph-Duncan, Marilyn
Raymundo Coyoc
B: 1947-03-15
D: 2019-01-01
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Coyoc, Raymundo
Mary F. Houston
B: 1939-08-20
D: 2018-12-28
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Houston, Mary F.
Dorothy Williams
B: 1937-11-27
D: 2018-12-25
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Williams, Dorothy
Robin Stuckey
B: 1958-04-21
D: 2018-12-20
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Stuckey, Robin
Jorge Reyes Castro
B: 1977-12-31
D: 2018-12-11
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Reyes Castro, Jorge
Avtar Singh
B: 1946-03-31
D: 2018-12-06
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Singh, Avtar
Darshan Kaur
B: 1942-02-07
D: 2018-11-23
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Kaur, Darshan
Tejus Kumar
B: 2018-11-19
D: 2018-11-21
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Kumar, Tejus
Audreen Profitt
B: 1952-10-15
D: 2018-11-20
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Profitt, Audreen
Shingara Ram
B: 1956-02-10
D: 2018-11-16
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Ram, Shingara
Daphne Cunningham
B: 1945-07-15
D: 2018-11-16
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Cunningham, Daphne
Mahadaiah Samaroo
B: 1942-12-01
D: 2018-11-14
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Samaroo, Mahadaiah

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Elcock Funeral Home, Inc. ... Your Faith, Our Home ®
130-02 Liberty Ave.
Queens, NY 11419
Phone: (718) 845-7408
Fax: (718) 845-7477

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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:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

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