PRE-PLANNING

A pre-arrangement information form follows. For your convenience, please feel free to provide us with the information that is typically necessary for the various legal and practical needs that arise following death. Once this information is received, we will keep it on file and send to you a letter of confirmation.

If you wish, you may set up a free consultation with one of our professional pre-planners to meet with you. Please call us at 724-287-3706. 

GENERAL INFORMATION:
Full Name:	Nickname:		Age:
Street Address:			City:
State:	Zip Code:		Township:
County:	Social Security #:		Place of Birth:
PARENTS:
Fathers Name:	Mother's Maiden Name:
SPOUSE:
Spouse Name:	Date Married:		Date of Death, if Deceased:
Your Occupation:			Where did you work:
If Retired, Date?
SURVIVORS:
Spouse:	Parent (Father) Name:		Parent (Mother) Name:
Son 1:	Son 2:		Son 3:
Daughter 1:	Daughter 2:		Daughter 3:
Brother 1:	Brother 2:		Brother 3:
Number of Grandchildren:	Number of Great-Grandchildren:		Number of Nieces:
Number of Nephews:
FUNERAL SERVICE:
Where would you like the funeral service to be held?  Church or Funeral Home
What pastor/lay-minister would you like to perform the service?
What church is the pastor/lay-minister from?
Are you a member of a Church?
If yes, Name of Church?
ORGANIZATIONS:
Organization 1:	Organization 2:		Organization 3:
INTERESTS:
Interest 1:	Interest 2:		Interest 3:
EDUCATION:
High School You Attended:			How Many Years Did You Attend?
College You Attended:			How Many Years Did You Attend?
What Degree Did You Receive?
MILITARY:
Were You In The Military?	Rank When Discharged?		Serve During Peace or War Time? Peace Time   War
Where Did You Serve?
Are You Able to find your discharge Papers? (DD-214) Funeral Home will need a copy.
CEMETERY:
Cemetery Name?
Do You Own Space/Spaces there?   Yes     No
Will You Be Buried Beside Someone?   Yes      No
MEMORIALS:
Who Should Memorial Donations Be Made to?		Is this In Lieu Of Flowers? Yes      No
CONTACT INFORMATION:
Contact Name?	Street Address:
City:	State:		Zip Code:
Phone Number:	Relationship?		Social Security Number: