162-05 Horace Harding Expressway
Fresh Meadows, NY 11365
Phone: (718) 445-0300
Fax: (718) 321-0896

Statistical Questionnaire

Full English Name:

Hebrew Name:

Father's Hebrew Name:

  Cohen          Levi          Israelite
Current Legal Residence:

Email:
Phone: Date of Birth:
Age: SSN: This information will be collected at a later date

Other legal names or AKA's used:

Years of Military Service
(if applicable):

Branch:

Marital Status:

Married/Separated  

Divorced     

Widowed

Never Married

Surviving Spouse?
(Maiden) Name:

Usual occupation (not "retired"):

Business or industry:

Name and location of company:

Highest level of education completed: 

City and State of Birth
(If outside US, give country):

Father's Full Name: 

Mother's Maiden Name:

Nearest Living Relative:

 

 

 

 

 

Name:

Relationship:

Address:

Phone: 


 

Other survivors' names, address and phone numbers:

Cemetery Information Name of Cemetery:

  Section:

Block: Plot: Grave:
  Next to: 

  Deeded? Signer of Permit:

  Society or Organization:

I would like more information on:

Preplanning
Funeral Costs
Funeral Etiquette
Value of Family Ownership
Death Away from Home
Personalizing a Funeral
Helping Children Cope with Death
Questions & Answers about Funerals
The Sinai Difference
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