Personal History

Click here to download our Personal History Form or fill it out below and hit submit.

First Name
Middle
Last
Nickname
Maiden Name
Gender
Address
City
State
Zip
Phone
Cell
Township/Boro
County
Residence Since
Previous City & State
   
History  
   
Date of Birth
Place of Birth
SSN#
Education Level
Occupation
Job Title
   
Parents  
   
Father's Name
Mother's Maiden Name
Maritial Status
Spouse's Name
Wedding Anniversary
   
If A Veteran  
   
Branch of Service
Serial #
Discharge Date
   
Memberships  
(churches, unions, organizations, etc.)
   
My Family  
   
Name
Address
City
State
Zip
Phone
Relationship
   
Name
Address
City
State
Zip
Phone
Relationship
   
Name
Address
City
State
Zip
Phone
Relationship
   
Name
Address
City
State
Zip
Phone
Relationship
   
Name
Address
City
State
Zip
Phone
Relationship
   

 

 

 


Bartron Myer Funeral Home
Gregory L. Myer - Supervisor

74 Church Street
Montrose, PA 18801

Toll Free Phone: 1-877-860-2170
Local Phone: 570-278-1177
Fax: 570-278-3108