Barry  J. Farrell Funeral Home
Full Name:
Street Address:
Zip:
State:
City:
Telephone:
Sex:
Social Security #:
U.S. War Veteran:
Education:
Date of Birth:
Birthplace:
Married:
Never Married:
Widowed:
Divorced:
Last Spouse:
Usual Occupation:
Industry:
Fathers Full Name:
State of Birth:
State of Birth:
Mothers Full Name (Maiden):
Religion:
Services Requested At:
Clergy Requested:
I Request:
Burial:
Other:
Cremation:
Location of Burial:
Casket Selected:
Burial Vault:
Executor/Executrix:
Clubs/Organizations:
Military Information:
Date entered into military:
Date of discharge:
Rank:
Service Number:
Branch of service:
Please list survivors as they should appear in obituary:
1.
6.
2.
7.
3.
8.
4.
9.
5.
10.
Contact Us
Family owned and operated since 1986
2049 Northampton St.
Holyoke, MA 01040
413-536-3843
2049 Northampton Street
Holyoke, MA  01040
(413) 536-3843  Telephone
(413) 536-5979 Facsimile
Information required for pre-arranged funeral
Please s completed form by clicking on Submit button
at end of form