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GENERAL PRICE LIST
ABOUT US
OBITUARIES
SERVICES
PLAN AHEAD
GRIEF SUPPORT
RESOURCES

Online Planning Form

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VITAL STATISTICS

Legal Name

Address

City

State

Zip Code

Home Phone

Race

Social Security Number

Marital Status

Married

Never Married

Widowed

Divorced

Spouse

Occupation

Business/Industry

Employer

Retired

Yes

No

High School Attended

College Attended

Degree(s) Received

Father's Name

Is Father Living?

Yes

No

Mother's Full Name (Including Maiden Name)

Is Mother Living?

Yes

No

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FUNERAL SERVICE INFORMATION

Preferred Service

Traditional Funeral Service

Graveside Service

Traditional Service Followed by Crematio

Immediate Burial

Graveside Service

Cremation with Memorial Service

Immediate Cremation

Place of Service

Funeral Home

Church

Gravesite

Cemetery Chapel

Home

Other

Religious Preference

Clergy

Participating Organizations (military, fraternal, lodge, etc)

Flag

Draped

Folded

Presented To

Visitation/Gathering

Public

Private

None

Wake/Rosary Service

Yes

No

Location

Officiant

Clothing Preference

From Current Wardrobe

New

Other

Description/Color

Jewelry Description

Handling Preference:

Stays on

Return to

Return to (If being returned)

Eyeglasses

Handling Preference:

Stays on

Return to

Return to (If being returned)

Other Description

Other Description Accessories

Stays on

Return To

Pallbearers

Floral Preference (Type, Color)

Memorial Donations May Be Made To

Organist

Soloist(s)

Musical Selections

Religious Passages or Poems Selected

Eulogy by

Eulogy Notes

Newspaper Notices

Casket

Open Casket

Closed Casket

Type of Casket

Hardwood

Metal

Cremation

Earth Friendly

Other

Description

Urn

Metal

Marble

Cloisonne

Scattering

Earth Friendly

Services/Merchandise Noted are Prepaid and Contract/Policies can be Located at

Additional Information/Special Instructions

Cemetery & Memorialization Information

CEMETERY & MEMORIALIZATION INFORMATION

Cemetery

Address

City

State

Zip Code

Phone

Traditional Burial Space

Own

Need

If owned which section,

Types of Arrangements

Family Estate

Companion

Single

Type of Burial Rights

Mausoleum

Lawn Crypt

Ground Burial

Cremation with Memorialization

If owned, the Name of Person who Interment Rights are Deeded to

Location of Deed

Cremation Disposition

Burial

Mausoleum

Scattering Garden

Cremation Garden

Niche

If Other Please Specify

Memorial Plaque Inscription

Cremated Remains Container

Urn

Keepsake Memorial

If Other Please Specify

Description

Permanent Memorialization

Own

Need

Inscription

Emblem(s)

Accomplishments

Family present during closing of property

Yes

No

Opening and Closing of property

Prepaid

Not Prepaid

Additional Remarks/Special Instructions/Items to be Placed with the Remains, Etc.

Additional Remarks/Special Instructions/Items to be placed with the remains, etc.

Obituary Worksheet

OBITUARY WORKSHEET

Name

Age

City

State

Beloved (Husband/Wife) of

Birth date

City of Birth

State of Birth

Parent's Names

Children's Names

Siblings Names

Grandchildren

Hobbies/interests

Service Date and Times.

Mass of Christian Burial/Funeral Service/Memorial Service will be held at,

Followed by Interment/Inurnment/Entombment at,

Flowers, Memorial Contributions may be made to,

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PEOPLE TO CONTACT

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Please list the significant people in your life that the funeral home should reach out to upon your death.

Name

Relationship

Address

Phone

Name

Relationship

Address

Phone

Name

Relationship

Address

Phone

Name

Relationship

Address

Phone

Name

Relationship

Address

Phone

Notes

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FD 2497

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