PRE-PLANNING

Thinking about death, to say nothing of planning for your own or that of a family member, is often an uncomfortable subject to discuss. Nevertheless, funeral planning before the need arises is an important topic. Planning ahead is certainly not a new concept. People have always prepared wills, purchased life insurance and even selected their own cemetery lot. Funeral planning merely takes this step further, by meeting with a funeral director to discuss your own arrangements or those of a loved one in advance.

Personal Information

Marital Status:

Social Security Number:

Date Of Birth:

Place Of Birth:

Address:

City:

State:

Country:

Zip Code:

Day Phone:

Evening Phone:

Fax:

Email:

Spouse's Name:

Spouse's Maiden Name:

Place Of Marriage:

Date Of Marriage:

Father's Name:

Mothers Name:

Mother's Maiden Name:

Physician's Name:

**Person In Charge Of Final Arrangements**
First Name:		Last Name:
Address:		City:
State:		Zip Code:
Day Phone:		Evening Phone:

Person In Charge Of Final Arrangements

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Day Phone:

Evening Phone:

Education And Work History

Education (0 - 12):

College (1-5+):

School Attended:

Graduation Year:

School Attended:

Graduation Year:

School Attended:

Graduation Year:

School Attended:

Graduation Year:

Occupation:

Industry:

Employer:

**Military Record**
Branch Of Service:		Serial Number:
Date Enlisted:		Rank At Discharge:
Date Of Discharge:		Discharge On File At:
Copy Of Discharge Papers:		Name Of Wars:

Military Record

Branch Of Service:

Serial Number:

Date Enlisted:

Rank At Discharge:

Date Of Discharge:

Discharge On File At:

Copy Of Discharge Papers:

Name Of Wars:

Funeral Service Arrangements

Place Of Service:

Length Of Visitation:

Hours Of Visitation:

Religious Denomination:

Place Of Worship:

**Newspaper Information**
Spouse:
Children:
Brothers And Sisters:
Grandchildren:
Great Grandchildren:
Others:

Newspaper Information

Spouse:

Children:

Brothers And Sisters:

Grandchildren:

Great Grandchildren:

Others:

**Organizations**
List All Relevant Organizations:

**Miscellaneous**
Jewelry:
Glasses:
Clothing Preference:
Funeral Breakfast Location:

Miscellaneous

Jewelry:

Glasses:

Clothing Preference:

Funeral Breakfast Location:

Disposition Request

Burial Preference:

Cemetery Name:

Cemetery Address:

Cemetery Phone Number:

Section:

Lot Number:

Grave Number:

Disposition Of Cremated Remains

Burial Location:

Scattering Location:

Other:

**Other Instructions / Comments**
Other Instructions / Comments:

**Memorials / Donations To Charity**
Memorials / Donations To Charity:

**Please Select All That Apply**
Send Information About Pre-Arrangement:
Contact me To Set Up An Appointment:
Please Keep my Information On File:

Please Select All That Apply

Send Information About Pre-Arrangement:

Contact me To Set Up An Appointment:

Please Keep my Information On File: