Pre-Planning 

  

 
Pre-planning is an appropriate way of arranging one's funeral, free of the emotional stress and grief that follow a death.  We offer, with no obligation, information and counseling on pre-planning and the financing options of funerals.  Trusts and insurance programs are available with a variety of payment options that can be tailored to fit each individual need.
 
 Below is an information page that will assist you in recording vital statistics and planning through the type of service you desire.  Once you complete the form it can be submitted to us for safe-keeping, or given to a close friend or family member.  More detailed arrangements can be made by scheduling an appointment with us, either in our facility, or in the comfort of your own home.  These matters are private and will not be shared without your permission.
 
  

 

 

 

Personal Information             
Name:
Address:
City, St ZIP:
Phone:
Birth Date:
Birth Place:
Status: Never Married     Married     Widowed     Divorced
Spouse's Name:
  Vital Statistics
Social Security #:   
Usual Occupation:
Years of Education:
Race:
If Hispanic-List Origin:
Veteran Info: Yes     No
Branch of Service: 
Rank: 
Do you desire a military funeral?       Yes     No
DD-214 Location:
Church Membership
Civic orgs. & Clubs

Survivors

Include names and the city of residence for each living relative.  Deceased relatives can be included below.
This information is helpful for the obituary notices.

Spouse:
Daughters:
Sons:
Parents:
Brothers:
Sisters:
Number of Grandchildren:   
Number of Great Grandchildren:    
Number of Great-Great Grandchildren:    
Preceded in death by:

                        

Please list relation first then the name.

 

                                 Funeral Service Preferences
Place funeral will be held:
Visitation/Wake Information:
Minister(s):
Musicians:
Favorite Song(s):
Pallbearers:   (At least six)
    
Honorary Pallbearers:

I prefer:

   Burial     Cremation      Entombment     Body Donation
Cemetery Info: Name: 

Deeded To: 

Section       Lot     
Grave    Other
Memorials: Church or Charity: 
Address:
One Handling My Affairs: Name:
Address:
Phone:
Insurance Information: Company:
Agent:
Would you like to receive confirmation that we received this information via regular mail?

   Yes            No

Everyone will receive an e-mail confirmation if you provide your e-mail address:
Name of person submitting this information:                
Your e-mail address:
 

 

 

 
 

Cottonman