Phone: (765) 474-1111 Fax: (765) 477-1292
Email: familyservices@soller-baker.com
Soller-Baker Funeral Homes, Inc.
400 Twyckenham Blvd. Lafayette, IN 47909
Please enter your email address:
General Information
Last Name
First Name
Middle Name
Address
City
State
Zip
Phone
Social Security #
Birth Date
Place of Birth
Marital Status
Spouse's Name
Marriage Date
Place of Marriage
Religious Affiliation
Occupation
Father's Name
Mother's Name
Education
High School Name
City, State
Graduation Year or Years Complete
College Name
City, State
Graduation Year or Years Complete
Special Interests
Military Service Branch
Military Service Dates
Memberships (Fraternal/Union)
Special Recognitions
Hobbies & Interests
Clubs & Groups
Funeral Arrangements
Funeral Home
Preferred Service Location
Clergy Person
Clergy Phone
Clergy Person
Clergy Phone
Military Services
Fraternal Services
Music Desired
Flowers
Cemetery Name
Address
City, State
Phone
Memorials
Special Instructions
Authorization
I,
, do hereby certify and acknowledge that the information recorded herein was personally
given to
representing Soller-Baker Funeral Homes, Inc.
Authorized by
Date
Soller-Baker Representative
Date
Children
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Brothers and Sisters
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Name
Spouse
City, State, Zip
Phone
Preceded By
Grandchildren
Great Grandchildren
Great-Great Grandchildren
Other Pertinent Information
Soller-Baker Funeral Homes, Inc. · 400 Twyckenham Blvd. · Lafayette, IN · Phone: (765) 474-1111 · Fax: (765) 477-1292 · www.soller-baker.com