Biographical Form

  • Vital Statistics

PLEASE NOTE: If you have entered information after hours, and need immediate assistance, please call (845) 331-0625 or use our web chat feature, otherwise all information will be reviewed by 8:00 a.m.


Please read carefully, this section contains information that we are required to gather, by New York State law. Please answer each question to the best of your ability. If you do not have this information, or are unsure, please enter "Unknown". We will review this information with you. Before any documents are submitted we are required, by law, to have your review and signature. Thank you

Contact Person (referred to by NYS as Informant) Person doing the planning

Address of Informant

Please use the following format _ _ _- _ _ _ - _ _ _ _ 

Please use the following format _ _ _- _ _ _ - _ _ _ _ 

Please answer to the best of your ability. 

Beneficiary Information: (who plan is for)

Address

By NYS Law, we cannot use PO Box as address, please enter physical address, use house number, mailbox number or 911 fire number.  If you are not sure, we will review with you. Please complete to best of your ability.

DD/MM/YYYY

(city, town, village)

MUST follow __ __ __ - __ __ - __ __ __ __  format 

Even if retired, NYS Law requires this information. If disabled, please enter disabled, if unknown, please enter unknown, if homemaker, please enter homemaker, if self employed, please enter type of self employment. We also understand a person may have had several occupations, but NYS law allows only one entry.

If you are not sure, please enter “unsure” we will review with you.

Employment Of Beneficiary (who plan is for)

Example - carpenter, teacher, administrator

Example - construction, education, technology

Example - Carpenters Local #123, Kingston Consolidated Schools, IBM Kingston 

If you do not have this information insert 'Unknown'

Father Of Beneficiary (who plan is for)

If you do not have this information insert 'Unknown'

Mother Of Beneficiary (who plan is for)

By NYS state law we are required to gather this information - Please note, if wife is surviving, provide maiden name. 

If you do not have this information, please insert 'Unknown'

Marital Status

List 1st name, Last name. - If wife, list First name then Maiden name.
If not or never married or if you do not have this information insert 'Unknown'

 

It is very important that we have as accurate information as possible.  A veteran is entitled to many benefits, with out the proper documents, we will not be able to help you file for those benefits. If you don’t know, please enter unsure.   

We will do everything possible to make sure the veteran receives all the benefits they have earned by serving our country.

Military Status

If not, we may be able to help you obtain a copy

Year range - Example: 1950 - 1955

The following is a list of the information that we will need to complete funeral arrangements.  Many of the areas are self-explanatory; other areas will require more in-depth information.  Please feel free to contact us at anytime if you have any questions.  

Additional Biographical Information

If Yes, please enter name of church

Funeral Instructions

If Church - Please enter name of church
If Other - Please describe

Burial or Cremation Information

If other, please describe

If Cremation
If Burial/Entombment
Survivors
Special Instructions

Please enter name, address & website.

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