PRE-PLANNING FORM

No one likes to think about death, let alone plan for it. In many families, discussing one's mortality is an extremely uncomfortable topic. But it is a topic that should be discussed and planned for well in advance of your death.

Full Name:

Date of Death:

Vital Statistics

Deceased's Address:

City:

Township:

County:

Zip:

State:

Place of Death:

City:

Township:

County:

State:

Sex:

Color:

Marital Status:

Date of Birth:

Birth Place:

Father's Name:

Mother's Name & Maiden Name:

Spouse's Name & Maiden Name:

Usual Occupation:

Employer:

Veteran:

Branch of Service:

Rank and Service Number:

Informant:

Relationship:

Address:

Family Telephone:

Cell Phone:

Doctor:

Number of Certified Copies:

Send to:

Ancestry:

Education:

Service Details

Place:

Date:

Time:

Clergy:

Music:

Jewelry Instructions:

Pallbearers:

Family Time:

Visitation Hours:

Military Rites:

In Lieu of Flowers:

Final Disposition

Date:

Cemetery/Crematory:

City:

Township:

County:

State:

Description of Grave:

Disposition of Ashes:

Obituary Biographical Information

Hobbies and Special Interests:

Memberships:

Nickname:

Raised:

Length of Time Locally:

High School:

College:

Work History (Retirement Date):

Survivors

Father:

Mother:

Husband/Wife:

Daughters:

Sons:

Sisters:

Brothers:

Grandchildren (no.):

Great Grandchildren (no.):

Nieces/Nephews:

Cousins: