Advance Planning
Why prearrange?

Prearranging your funeral is a simple and secure way to provide for your final arrangements. The
advantages to pre-arranging are many, but most importantly, it ensures that your wishes will be
carried out, down to the last detail. It is a valuable and protected investment and is one of the kindest
gifts you can give your family. We understand that making the many decisions which come at a time
of loss can be difficult. We offer our support by providing you with options as you consider making
arrangements.  We work directly with a variety of state and private agencies to assist families applying
for Title 19.  Planning ahead allows us to obtain all possible benefits for your family.  Our purpose is to
provide you with the information necessary to make sensible decisions for the future.
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If you'd like to submit responses to these questions now for our files, please complete the following
information.
Enter the following information for the person whom the arrangements are for.
    Full Legal Name (first, middle, last)
    Legal Address (place of residence)
    City, State, Zip Code
    Date of Birth
    Place of Birth - City, State
    Martial Status
    Name of Spouse, if applicable
    Highest Level of Education
    Employer
    Occupation/former occupation
    Kind of Business/Industry
    Length of Employment
    Other places employed
    Father's First & Last Name
    Mother's First & Maiden Name
    Survivors: include children, brothers,
    sisters, and place of residence.
    Number of Grandchildren
 Great-
grandchildren
Great-great-
grandchildren
    Organizations, clubs, and
    hobbies
    Veteran Information - please bring a copy of the veteran's DD-214 discharge papers.
    Branch of Service
    Veteran's Service
    Decorations,
    citations, and/or
    other service
    information
    Who will be responsible for making
    these arrangements at the time of
    death?
    Relationship
    Address
    City, State, Zip Code
    Phone
    Email
    How can we contact you:
    Name
    Email
    Telephone
    My wish (or the person these arrangements are for) is to be
    If you chose cremation, the ashes will be
    If you chose burial or if the ashes will be
    buried, what cemetery will you use?
    Where is that cemetery located?
    I
 like to allow time for my family to receive family
and friends at the funeral home.
    I would like this time to be
    The service will be held at
    What is your church affiliation?