Obituaries

James Pearce
B: 1940-10-20
D: 2019-09-16
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Pearce, James
Leonard Hill
B: 1939-07-17
D: 2019-09-14
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Hill, Leonard
Marion Covey
B: 1925-12-10
D: 2019-09-12
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Covey, Marion
Evelyn Rowe
B: 1950-04-24
D: 2019-09-12
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Rowe, Evelyn
Angelina Kelson
B: 1956-08-25
D: 2019-09-12
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Kelson, Angelina
Shelby Siegrist
B: 1939-06-08
D: 2019-09-10
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Siegrist, Shelby
Timothy Keilholtz
B: 1951-01-01
D: 2019-09-10
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Keilholtz, Timothy
Steven Gladhill
B: 1958-09-17
D: 2019-09-09
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Gladhill, Steven
Mary Dagliano
D: 2019-09-09
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Dagliano, Mary
Darlene Holloway
B: 1944-05-23
D: 2019-09-06
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Holloway, Darlene
Robert Klipp
B: 1942-08-02
D: 2019-09-06
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Klipp, Robert
Evelyn Thys
B: 1931-07-30
D: 2019-09-06
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Thys, Evelyn
Rebekah Carothers
D: 2019-09-06
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Carothers, Rebekah
Debra Hildebrand
B: 1962-12-06
D: 2019-09-05
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Hildebrand, Debra
Willard Jones
B: 1950-07-01
D: 2019-09-04
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Jones, Willard
Michael Bingaman
B: 1963-08-12
D: 2019-09-04
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Bingaman, Michael
Roger Athey
B: 1945-07-21
D: 2019-09-03
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Athey, Roger
Tammy Grubbs
B: 1962-05-19
D: 2019-08-30
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Grubbs, Tammy
Douglas Wyatt
B: 1952-12-10
D: 2019-08-29
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Wyatt, Douglas
Henry Conner
B: 1950-09-06
D: 2019-08-26
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Conner, Henry
Bonnie Thorn
B: 1945-10-10
D: 2019-08-25
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Thorn, Bonnie

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305 N. Potomac St.
HAGERSTOWN, MD 21740
Phone: (301) 739-5498
Fax: (301) 733-6369

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If your family has just lost a loved one and are in immediate need, please accept our sincerest condolences. Whether it was expected or not, losing a loved one is never easy. Rest assured, our staff of caring and knowledgeable funeral directors will be here to assist you every step of the way. We make it a priority to assist you to the best of our ability and ensure that we make the arrangement process easy and straightforward.

To begin moving forward with the arrangement process, it is very important that we collect specific information immediately. Please take a few moments to fill out the form provided below. Please note that we understand that you may have information for every section below. We simply ask that you provide us with as much information as possible, so we can begin moving forward with the completion of legal documents and arranging the service.

Upon completion of the form, you will be contacted shortly thereafter by a member of our staff. They will ask you to arrange a time to come and visit us at the funeral home so we can finalize the arrangement process. We understand how difficult this experience can be and want you to know that we will be here to assist and support you every step of the way. If you have any questions or concerns, please do not hesitate to contact us.

You can reach us at any time by calling (301) 739-5498 or emailing us at tim.harman@potomaccremation.com and a member of our staff would be happy to assist you.


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