We have included the following list of information that will be helpful to establish a prearranged funeral. This information can be printed out and given to the funeral home, or to a family member. If you should have any questions, please do not hesitate to call or e-mail us. Thank you.
Biographical Information
Full Name:
Date of birth:
City & State of birth:
Social Security Number:
Father's name:
Mother's maiden name:
Your Address:
Phone number:
How many years in this location?
Former location:
Highest grade of education completed:
If you worked outside of the home,
Occupation:
Last place of employment:
Marital Status:
Name of spouse:
Veteran:
(Please keep a copy of your discharge papers with this sheet)
Branch of Service:
Receiving Veteran's disability or pension?
Next of kin:
Address:
Phone number:
Family Members
Please provide a list of family members that you would like included in your obituary. Also, please indicate the town in which they live.
Spouse:
Children (& Spouses):
Brothers (& Spouses):
Sisters (& Spouses):
Grandchildren:
Any additional survivors:
Please include any additional information that you would like included in your obituary, such as memberships, hobbies, etc.:
Service Requests
Services to be held at:
Clergyman or Service Leader:
Requests for readings or music:
Visitation:
Disposition:
Burial:
Cemetery:
City, State:
Grave Location:
Location of cemetery deed:
Cremation:
Please specify your wishes for the disposition of the ashes:
Clothing requested:
Jewelry:
Flowers:
Memorials:
Other instructions:
Information for Your Family
The following information will be helpful to your loved ones in the event of your death. It should be kept so that it will be available to your survivors at the time of need.
1. Location of my will:
Executor named:
Attorney's name & phone number:
2. I have Bank Accounts at:
3. Safety Deposit Box number:
Bank:
Location of key:
4. I have Insurance Policies with:
Location of insurance paperwork:
5. Real Estate owned:
Deeds are located:
6. I have Stocks or Bonds. My broker is:
Location of paperwork:
7. Location of Cemetery papers:
8. Location of Veteran Discharge Papers:
I was receiving veterans benefits (explain):
9. Location of Title for motor vehicle(s):
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