Being prepared..... is having peace of mind.

This form is a guide to the information requested by your funeral director when making funeral arrangements. Please fill out the form as completely as possible (not all fields must be filled out). Let us know if you have any questions.

Pre-Planning Form
Name of the person filling out this form (First Last):
Your phone number:
Your email:
I am planning for

Personal Information

Full Name (First Middle Last):
Gender:
Marital Status
Address:
City:
County:
State:
Zip:
Phone:
Social Security Number:
Date of Birth: (mm/dd/yyyy)
Place Of Birth:
Spouse's Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage: (mm/dd/yyyy)
Place of Marriage:
Father's Name:
Mother's Maiden Name:

Current surviving family (information will be updated at the time of death):

Preceded in death by:

Employment & Education History

Education Level: Primary:
  Secondary:
Occupation:
Employed by:
# Of Years:
Retired in:

Military Service

Service Branch:
Date Enlisted: (mm/dd/yyyy)
Date Discharged: (mm/dd/yyyy)
Rank At Discharge:
Discharge On File At:
Location of my discharge:
Name of any wars served in:

Funeral Preferences

I Prefer My Funeral Service To Be:
Place Of Service:
Religious Denomination:
Place Of Worship:
Worship leader:
Name of worship leader:
Casket Bearers (6): 1.
  2.
  3.
  4.
  5.
  6.

Memorialization Instructions
Musical Selections
To Be Played:
1.
  2.
  3.
  4.
  Will Supply CD/Tape
Musical Selections
To Be Sung:
1.
 (usually use two selections) 2.
  3.
  4.
Favorite Bible Passages:
Favorite Literature or Poems:
Favorite Flower(s):
Favorite Flower Color:
Please list any memorials or donations to charity that you would like:

Final Disposition

Preference for final disposition is (check one): Ground interment with
  Mausoleum
  Cremation with
Preference of cemetery:
Address of cemetery:
Check if a cemetery plot 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:
   
Please complete above validation key before completing the contact form.

Send me information on pre-arrangement
Contact me to set an appointment
Keep my information on file


 

© 2008-2013 Elwood Funeral Home.
Designed byRural Designs.