Merchandise
Pre-Planning
For the Bereaved
Obituaries


This form is provided as a service to allow you to record funeral preferences for yourself or a loved one. If you are not comfortable sending this information in an e-mail message, please feel free to contact us directly or print this page and deliver it to us.

I am planning for
Personal Information
Name (First MI Last):
Date of Birth: Place Of Birth:
Address: City:
County: State: Zip:
Phone: E-mail:
Spouse's Name: Spouse's Maiden Name:
Place of Marriage: Date of Marriage:
Father's Name: Mother's Name:
Mother's Maiden Name:

Work/Education History
Education Level: Primary:
Secondary:
Occupation:
Business: Industry:
Company: Number Of Years:

Military Service
Service Branch: Serial Number:
Date Enlisted: Rank At Discharge:
Date Discharged: Discharge On File At:
Name Of Wars:

Funeral Preferences
I Prefer My Funeral Service To Be
Place Of Service:
Conclude Service At:
Religious Denomination:
Place Of Worship:
Name:
I Prefer Package:
Type Of Clothing:
Preferred Casket Type:

Memorialization Instructions
Musical Selections To Be Played
Will Supply CD/Tape
Musical Selections To Be Sung
Favorite Scripture:
Favorite Literature Or Poems:
Favorite Flower(s):
Favorite Flower Color:

Final Disposition
Preference for final
disposition is:		 Ground interment with
Mausoleum entombment
Cremation with
Preference of cemetery or mausoleum is:
Address:
A is owned at the above location

Special Instructions

Person To Finalize Arrangements At Time Of Death
Name:
Relationship:
Address:
City: State: Zip:
Phone: E-mail: