Preplanning

Personal Information

First Name:

Middle Name:

Last Name:

Date of Birth:

Birthplace:

Address:


City:

State/Province:

Zip/Postal Code:

Phone:

Email Address:

 

Father's Name:

Address - if living:


City:

State/Province:

Zip/Postal Code:

 

Mother's Maiden Name:

Address - if living:


City:

State/Province:

Zip/Postal 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:


City:

State/Province:

Zip/Postal Code:

Child#2 Name:

Spouse's Name:

Address:


City:

State/Province:

Zip/Postal Code:

Child#3 Name:

Spouse's Name:

Address:


City:

State/Province:

Zip/Postal Code:

Child#4 Name:

Spouse's Name:

Address:


City:

State/Province:

Zip/Postal Code:

Child#5 Name:

Spouse's Name:

Address:


City:

State/Province:

Zip/Postal Code:

 

Current Number of Grandchildren:

Current Number of Great Grandchildren:

 

Names of surviving brothers & sisters and their addresses

Sibling#1 Name:

Address:


City:

State/Province:

Zip/Postal Code:

Sibling#2 Name:

Address:


City:

State/Province:

Zip/Postal Code:

Sibling#3 Name:

Address:


City:

State/Province:

Zip/Postal Code:

Sibling#4 Name:

Address:


City:

State/Province:

Zip/Postal Code:

Sibling#5 Name:

Address:


City:

State/Province:

Zip/Postal 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

If yes, what branch:

List membership in fraternal, civic, or professional organizations:

 

Special events in my life not listed previously:

 

FUNERAL INSTRUCTIONS

Place of Service:

Minister:

Minister:

Music Selections:

Organist:

Singer(s):

Singer#1:

Singer#2:

Singer#3:

Singer#4:

Singer#5:

Pallbearers:

Pallbearer#1:

Pallbearer#2:

Pallbearer#3:

Pallbearer#4:

Pallbearer#5:

Pallbearer#6:

Pallbearer#7:

Pallbearer#8:

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:


City:

State/Province:

Zip/Postal Code:

Phone:

Person#2 Name:

Address:


City:

State/Province:

Zip/Postal Code:

Phone:

Person#3 Name:

Address:


City:

State/Province:

Zip/Postal Code:

Phone:

Person#4 Name:

Address:


City:

State/Province:

Zip/Postal Code:

Phone:

Person#5 Name:

Address:


City:

State/Province:

Zip/Postal Code:

Phone:

 

My Special Wishes

Clothing, jewelry, etc.

 



Ronald McDonald House