Following is a useful form to gather all of the necessary information to begin pre-planning final arrangements.  Feel free to print this form and use it for your records.  Be sure to place the completed form in a place where family and friends will know to look in case they should need it.  Never place final arrangement information in a safe deposit box, as such boxes are rarely accessed before final arrangements need to be made.

Name:_____________________________________________

Sex:________Race:__________

Address:________________________City:________________

State:_______Zip:_______

Birth date: ____________________

Birthplace (City, County, & State):_________________________

Citizen of What Country:________________________________

Social Security #:_____________________________________

Spouse's Name (If wife, Give Maiden Name):________________________________________

Wedding Date:________________________________

Father's Name:________________________________

Address:_____________________________________

Mother's Maiden Name:__________________________

Address:_____________________________________

Personal History

Veteran:___________Branch:_______________

War:____________Service #:_______________

Employer:_______________________________

Address:________________________________

Position:________________________________

Number of Years Employed There :____________

Date Retired:___________________

Previous Employer:_______________________ Address:______________________________

Position:________________________________________

Number of Years Employed There :_______________ Date Retired:______________________

Education:_______________________________________

Church Membership:_______________________ Address:__________________________

Organizations/Offices held within church:________________________________________

Fraternal Organizations:_____________________________________________________

Offices Held in above:_______________________________________________________

Business or Service Organizations:_____________________________________________

Offices Held in above:_______________________________________________________

Public Offices Held:_________________________________________________________

Additional Information:_______________________________________________________

________________________________________________________________________

________________________________________________________________________

IMMEDIATE FAMILY

Name, Address, and Relationship:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

EMERGENCY CONTACT:

Name:___________________________________ Address:_________________________________

Home Phone: (____)__________________________
Work  Phone: (____)__________________________
E-mail address: _____________________________

Final Arrangement Information

Type of Service Desired:  

Traditional Funeral Service with visitation one day and burial the following day ( )

Traditional Funeral Service with visitation and burial the same day during normal working hours ( )

Traditional Graveside Funeral Service( ) 

Cremation with Viewing/Service( )

Cremation with  Memorial Service( )

Place of Service: 

Funeral Home( )

Church( ): ___________________________________________

Other Location: (Specify):________________________________

Publish Obituary: Yes( ) No( ) Private/Not announced Services: Yes ( ) No ( )

Viewing: Yes( ) No( ) 

Place of Interment: (Cemetery)_____________________________  Address:_____________________________________________

Name of Owner of Interment Rights:____________________________________

Block:_______Section:_____________Lot:________Space:____

Name of Clergy to Officiate:______________________________

Address of Clergy: _______________________________
Phone #:_____________________

Favorite Bible/Literature Passage:__________________________________________________

__________________________________________________________

Music Selections:____________________________________________

__________________________________________________________

Clothing: From Current Wardrobe ( ) New ( )

Jewelry:__________________________________________________

Participating Organizations (Fraternal or Military):__________________________________________________

Newspapers where obituary should appear:___________________________________________________

_________________________________________________________

Contributions (In lieu of flowers to be listed in newspapers):

_________________________________________________________

Additional information:___________________________________________________