pre-planning worksheet

Weeks after a death has occurred, when the family begins to think about all that has taken place, they may not be satisfied with the choices they made. A special poem or a favorite part of scripture may have been left out of the service, simply because it was not thought of at the time.
Please talk with your family and begin to put your ideas on paper by completing the following worksheet. We recommend taking time to think about your answers. If you would like to, choose "Save As" in your Browser and choose "Source" and you can fill out this form on your own. Or, you can print out this sheet and mail or fax it back to us or you can click "Submit" at the bottom and it will be sent to us automatically. Your privacy is held to the most strict standards. Never will your information be sold, traded, or given to anyone outside our funeral home. Guaranteed.
Pre-Planning Worksheet
             
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        Last Name:
                        
                        
                        
                        
                        
                        
                        
                        First Name:
                        
                        
                        
                        
                        
                        
                        
                        Middle Name:
                        
                        
                        
                        
                        
                        
                        
                        E-mail:
                        
                        
                        
                        
                        
                        
                        
                        Address:
                        
                        
                        
                        
                        
                        
                        
                        City:
                        
                        
                        
                        
                        
                        
                        
                        County:
                        
                        
                        
                        
                        
                        
                        
                        State:
                        
                        
                        
                        
                        
                        
                        
                        Zip Code:
                        
                        
                        
                        
                        
                        
                        
                        Phone:
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        Marital Status:
                        
                        
                        
                        
                        
                        
                        
                        Social Security#:
                        
                        
                        
                        
                        
                        
                        
                        Date of Birth:
                        
                        
                        
                        
                        
                        
                        
                        Place Of Birth:
                        
                        
                        
                        
                        
                        
                        
                        Spouse's Name:
                        
                        
                        
                        
                        
                        
                        
                        Spouse's Maiden Name:
                        
                        
                        
                        
                        
                        
                        
                        Place of Marriage:
                        
                        
                        
                        
                        
                        
                        
                        Date of Marriage:
                        
                        
                        
                        
                        
                        
                        
                        Father's Name:
                        
                        
                        
                        
                        
                        
                        
                        Mother's Name:
                        
                        
                        
                        
                        
                        
                        
                        Mother's Maiden Name:
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        Education (0-12):
                        
                        
                        
                        
                        
                        
                        
                        College 1-5+:
                        
                        
                        
                        
                        
                        
                        
                        Occupation:
                        
                        
                        
                        
                        
                        
                        
                        Business:
                        
                        
                        
                        
                        
                        
                        
                        Company:
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        Branch of Service:
                        
                        
                        
                        
                        
                        
                        
                        Serial Number:
                        
                        
                        
                        
                        
                        
                        
                        Date Enlisted:
                        
                        
                        
                        
                        
                        
                        
                        Rank At Discharge:
                        
                        
                        
                        
                        
                        
                        
                        Date Discharged:
                        
                        
                        
                        
                        
                        
                        
                        Discharge On File At:
                        
                        
                        
                        
                        
                        
                        
                        Copy of Discharge Papers:  
                        
                          Yes  
                        
                          No
                        
                        
                        
                        
                        Name Of  Wars:
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        Place Of Service:
                        
                        
                        
                         
                        
                        
                        
                        
                        Funeral Home:
                        
                        
                        
                        
                        
                        
                        
                        Address:
                        
                        
                        
                        
                        
                        
                        
                        Phone:
                        
                        
                        
                        
                        
                        
                        
                        Place of Visitation:
                        
                        
                        
                        
                        
                        
                        
                        Religious Denomination:
                        
                        
                        
                        
                        
                        
                        
                        Place Of Worship:
                        
                        
                        
                        
                        
                        
                        
                        Lodge / Union:
                        
                        
                        
                        
                        
                        
                        
                        Person in Charge of Final Arrangements:
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        Flower Preference:
                        
                        
                        
                        
                        
                        
                        
                        Music
                        
                        
                        
                        
                        
                        
                        
                        Casket Bearers (6):
                        
                        
                        
                        
                        
                         
                        

                        
                         
                        

                        
                         
                        

                        
                         
                        

                        
                         
                        

                        
                         
                        
                        
                        
                        
                        
                        
                        Jewelry:
                        
                        
                        
                        
                        
                        
                        
                        Glasses:
                        
                        
                        
                        
                        
                        
                        
                        Clothing:
                        
                        
                        
                        
                        
                        
                        
                        Other:
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        I Prefer:
                        
                        
                        
                        
                        
                        
                        
                        Cemetery:
                        
                        
                        
                         
                        
                        
                        
                        
                        Address:
                        
                        
                        
                         
                        
                        
                        
                        
                        Phone:
                        
                        
                        
                        
                        
                        
                        
                        Section:
                        
                        
                        
                         
                        
                        
                        
                        
                        Location:
                        
                        
                        
                        
                        
                        
                        
                        I have made a last will and testament:  
                        
                          Yes  
                        
                          No
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        Please list any other instructions you may have:
                        

                        

                                                
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        Please list any Memorials or Donations to Charity that you would like:
                        

                        

                                                
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        
                        Please select one of the options below
                        
                        :
                        
                        
                        
                        
                        
                        Send information about pre-arrangement
                        
                        
                        
                        
                        
                        Contact me to set an appointment
                        
                        
                        
                        
                        
                        Please keep my information on file

Last Name:
First Name:
Middle Name:
E-mail:
Address:
City:
County:
State:
Zip Code:
Phone:

Marital Status:
Social Security#:
Date of Birth:
Place Of Birth:
Spouse's Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage:
Father's Name:
Mother's Name:
Mother's Maiden Name:

Branch of Service:
Serial Number:
Date Enlisted:
Rank At Discharge:
Date Discharged:
Discharge On File At:
Copy of Discharge Papers: Yes No
Name Of Wars:

Place Of Service:
Funeral Home:
Address:
Phone:
Place of Visitation:
Religious Denomination:
Place Of Worship:
Lodge / Union:
Person in Charge of Final Arrangements:

Flower Preference:
Music
Casket Bearers (6):
Jewelry:
Glasses:
Clothing:
Other:

I Prefer:
Cemetery:
Address:
Phone:
Section:
Location:
I have made a last will and testament: Yes No

Please list any Memorials or Donations to Charity that you would like: