Being prepared..... is having peace of mind. This form is a guide to the information requested by your funeral director when making funeral arrangements. Please fill out the form as completely as possible (not all fields must be filled out). Let us know if you have any questions. Name of the person filling out this form (First Last): Your phone number: Your email: I am planning for myself my spouse my mother my father my child my friend other Full Name (First Middle Last): Gender: Male Female Marital Status Single Married Separated Divorced Widow Widower Address: City: County: State: Zip: Phone: Social Security Number: Date of Birth: (mm/dd/yyyy) Place Of Birth: Spouse's Name: Spouse's Maiden Name: Place of Marriage: Date of Marriage: (mm/dd/yyyy) Place of Marriage: Father's Name: Mother's Maiden Name: Current surviving family (information will be updated at the time of death): Preceded in death by: Education Level: Primary: 0 1 2 3 4 5 6 7 8 9 10 11 12   Secondary: 0 1 2 3 4 5+ Occupation: Employed by: # Of Years: Retired in: Service Branch: Date Enlisted: (mm/dd/yyyy) Date Discharged: (mm/dd/yyyy) Rank At Discharge: Discharge On File At: Location of my discharge: Bank Box Filed at Courthouse Unknown Other Location Name of any wars served in: I Prefer My Funeral Service To Be: Public Private Place Of Service: Funeral Home Church Cemetery None Other Religious Denomination: Place Of Worship: Worship leader: Elder Priest Clergyman Rabbi Reader Name of worship leader: Casket Bearers (6): 1.   2.   3.   4.   5.   6. Musical Selections To Be Played: 1.   2.   3.   4.   Will Supply CD/Tape Musical Selections To Be Sung: 1.  (usually use two selections) 2.   3.   4. Favorite Bible Passages: Favorite Literature or Poems: Favorite Flower(s): Favorite Flower Color: Please list any memorials or donations to charity that you would like: Preference for final disposition is (check one): Ground interment with Concrete Liner Burial Vault   Mausoleum   Cremation with Burial Home Memorialization Scattering Preference of cemetery: Address of cemetery: Check if a cemetery plot is owned at the above location Name: Relationship: Address: City: State: Zip: Phone: E-mail: Send me information on pre-arrangement Contact me to set an appointment Keep my information on file