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Use this form to plan for the event of yours or someone else's Funeral. Your answers will remain confidential and will never be sold or misused by anyone within our organization. If you are not comfortable in submitting this information online, please
call us
. We'll be glad to serve by phone.
Your Full Name:
Your Maiden Name:
Street/Mailing Address:
Telephone:
Race:
Sex:
D
ate of Birth:
Place of Birth:
Names of Parents:
Address of Parents
(if still living)
:
Social Security Number:
Marital Status:
Date of Marriage:
Names of Previous Spouses:
Names of Children:
Addresses and Phone numbers of Children:
Names of Brothers and Sisters:
Addresses and Phone numbers of Brothers and Sisters:
Names of other friends and relatives who should be notified:
Addresses and Phone numbers of other friends and relatives
:
Occupation(s) & Job title:
Type of Business/Industry:
Names of present and previous employers:
Addresses and Phone numbers of
present and previous employers:
If you are a veteran
Date of enlistment:
Place of enlistment:
Date of discharge:
Place of discharge:
Rank:
Service Numbers:
Company:
Organization or outfit:
Commendations received:
Location of discharge papers:
War:
Branch of Service:
Funeral Service Location:
Visitation/Viewing Location:
Church affiliation:
Professional and fraternal organization memberships:
Union and Clubs:
Education (list schools attended and dates of any degrees or honors received):
Education level:
Elem/Sec
College (1-4 or 5+)
School:
Names of newspapers for obituary:
Funeral director or funeral home you prefer:
Clergyperson or anyone else you would like to officiate:
Music, hymns or readings you would prefer during your service:
Memorial Donations you would like in your memory:
Names of casket bearers:
Method of Disposition:
Name of cemetery property:
Address and location of cemetery property (include lot and grave number):
Casket, vault and/or urn preference:
Flower preference for casket spray or other:
If you wish to be cremated, include disposition preference:
Location of will
:
The name of the executor of your estate:
Address and phone number of the executor of your estate:
Attorney's name:
Attorney's address and phone number:
Insurance company name and policy numbers:
Location of insurance policies:
Any additional instructions:
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