Burns Funeral Home

Preplanning your own, or a loved one's, funeral prior to death allows you to express your own wishes. Preplanning relieves your family of making stressful decisions at a difficult time. Preplanning does not require prepayment, however, a prepayment option is available.

The Burns Funeral Home is here to assist you with your funeral preplanning. You can contact us to arrange a time to meet, or you can start the process by completing and submitting this form via our secure server. If you wish for the Burns Funeral Home to contact you to arrange a meeting to discuss all of your options, please choose the appropriate option at the bottom of the form. If you wish, we can also file the information until you are ready to meet in person.

Please Note: This form should not be used to report a death of a loved one. In those cases, please immediately call the funeral home to make the proper arrangements at 978-663-3968 (Billerica) or 617-876-8336 (Cambridge).

Personal Information
	Name *(maiden)*		Soc. Security No.
	Gender		Race
	Date of Birth		Place of Birth
	Street Address		City
	State	Zip	County
	Home Phone		Email
	Father		Father's Birthplace
	Mother *(maiden)*		Mother's Birthplace
	Marital Status		Date of Marriage
	Spouse's Name		include maiden name if applicable.

Education & Occupation
	Yrs. of Education		Schools Attended
	Occupation		Business/Industry
	Employer		Years w/ Employer

Military/Veteran Information
	Branch of Service		Serial Number
	Wartime Service		List Wars/Conflicts
	Enlistment Date		Discharge Date
	Discharge Place		Highest Rank
	Org./Outfit

Next of Kin/Informant
	Name		Relation
	Street Address		City
	State	Zip	County
	Home Phone		Email

Funeral Service Information
	yes no	Funeral Home Visitation	Hours Desired
	yes no	Church Service	yes no	Funeral Home Service
	yes no	Cremation

Religious Affiliation
	Church		Denomination
	Location

Final Disposition
	Cemetery		City/State
	Phone		Section/Location

Other Affiliations - unions, fraternal organizations, community involvement, etc.


Obituary Information - family members, their spouses, towns, etc.


Additional Information - server will not accept web addresses.


	yes no	Contact me to schedule an appointment.
	yes no	Do not contact me. Hold information until I contact you.

Enter Security Code:

Please Note:
Once you click "Send Vitals" you will be redirected to a confirmation page.
If you are returned to this page, then the form has NOT been submitted.
If this should happen, please enter the new "Security Code" and hit
the "Send Vitals" button once again.

If you are unable to read the code, you can "Refresh" the page for
a new code to appear. This will not reset the information you
have entered. It will only give you a new code.