Pre- Planning Form

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Personal Information
First Name:
Middle Name:
Last Name:
Date of Birth:
Birthplace:
Address:
Street AddressCityStateZip Code
Phone:
Email Address:
Father's Name:
Address - if living:
Street AddressCityProvincePostal Code
Mother's Maiden Name:
Address - if living:
Street AddressCityStateZip Code
Where were you raised and what schools did you attend?
Highest level of education:
Maiden Name of Spouse:
Date of Marriage:
Place:
If deceased, date of death:
Where have you lived during your adult life?
Name of children & their spouses, and their addresses
Child#1 Name:
Spouse's Name:
Address:
Street AddressCityStateZip Code
Child#2 Name:
Spouse's Name:
Address:
Street AddressCityStateZip Code
Current Number of Grandchildren:
Names of surviving brothers & sisters and their addresses
Sibling#1 Name:
Address:
Street AddressCityStateZip Code
Sibling#2 Name:
Address:
Street AddressCityStateZip Code
Preceded in death by
Occupation. Give the type of work done most of working life, even if retired.
Name of Employer:
If Retired, Date of Retirement:
Total years spent in your occupation:
Church affiliation & activities:
Did you serve in the military?
- Yes
- No
List membership in fraternal, civic, or professional organizations:
Special events in my life not listed previously:
FUNERAL INSTRUCTIONS
Place of Service:
Minister:
Music Selections:
Organist:
Singer#1:
Singer#2:
Pallbearer#1:
Pallbearer#2:
Favorite Bible Selections:
Special Services (Military or Lodge)
Cemetery Information
Name of Cemetery:
Location City:
Lot is in the name of:
Section:
Lot:
Grave Space:
Casket and Burial Preferences
Casket:
- Metal
- Wood
Exterior Color:
Interior:
Burial Vault:
Authorized Persons to Arrange Final Details
Person#1 Name:
Address:
Street AddressCityStateZip Code
Phone:
Address
Street AddressCityStateZip Code
Person#2 Name:
Phone:
My Special Wishes
Clothing, jewelry, etc.

Personal Information

Name of children & their spouses, and their addresses

Names of surviving brothers & sisters and their addresses

FUNERAL INSTRUCTIONS

Cemetery Information

Casket and Burial Preferences

Authorized Persons to Arrange Final Details

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