Obituaries

Marilyn Nota
B: 1930-04-07
D: 2018-04-18
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Nota, Marilyn
Frank Gomez
B: 1938-04-07
D: 2018-04-17
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Gomez, Frank
Victor Diaz
B: 1934-02-25
D: 2018-04-12
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Diaz, Victor
Celestina Rodriguez
B: 1920-07-21
D: 2018-04-09
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Rodriguez, Celestina
Frank Jenkins
B: 1957-09-15
D: 2018-04-09
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Jenkins, Frank
Sarah Lopez
B: 1986-04-09
D: 2018-04-05
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Lopez, Sarah
Epifania Quinones
B: 1931-01-06
D: 2018-04-01
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Quinones, Epifania
Gioacchino Digirolamo
B: 1935-11-15
D: 2018-03-30
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Digirolamo, Gioacchino
Alicia Mulcare
B: 1967-05-10
D: 2018-03-28
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Mulcare, Alicia
James Mitchell
B: 1951-04-23
D: 2018-03-27
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Mitchell, James
Graham Laws
B: 1950-05-15
D: 2018-03-24
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Laws, Graham
Carol Dreyer
B: 1941-04-02
D: 2018-03-20
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Dreyer, Carol
Arthur Gager
B: 1986-02-16
D: 2018-03-19
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Gager, Arthur
Jeanne Panarella
B: 1960-06-26
D: 2018-03-17
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Panarella, Jeanne
Lawrence Raffo
B: 1926-11-04
D: 2018-03-16
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Raffo, Lawrence
Anna Maisonet Berrios
B: 1950-07-17
D: 2018-03-16
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Maisonet Berrios, Anna
Christopher Zanetis
B: 1980-10-24
D: 2018-03-15
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Zanetis, Christopher
Patricia Molle (Bohan)
B: 1940-04-05
D: 2018-03-13
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Molle (Bohan), Patricia
Peter Dellosso
B: 1927-06-30
D: 2018-03-10
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Dellosso, Peter
Charles Roman
B: 1951-07-08
D: 2018-03-06
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Roman, Charles
Maria Quintana
B: 1928-08-31
D: 2018-03-05
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Quintana, Maria

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43 2nd Ave
New York, NY 10003
Phone: 212-473-2220
Fax: 212-473-2263

Immediate Need

Let us take a moment to say we are so sorry for your loss. Whether death is expected or not, losing a loved one is difficult. We want to assure you that our knowledgeable and caring staff will make it a priority to assist you as best we are able and to do as much as possible to make the arrangement process as straightforward as possible.

As part of the arrangement process there is certain information that we will require and we’ve compiled a good portion of that in the form below. You can use the form to submit your information to us ahead of the meeting or simply use the form as a reference to make sure you have the documents you need. If you do choose to submit the form to us, we will be able to prepare more of the documents ahead of time, which will make the arrangement easier.

Additionally, if you have any questions at any point along the way, we will be here to support and assist you each step of the way. Don’t hesitate to call us at 212-473-2220 or email us at info@provenzanolanzafuneral.com if we can assist in any way.

 


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