PrePlanning and At Need Form

 
Personal Information
First Name Middle Initial Last Name
Address City State Zip
County Email Phone
Vital Statistics
Marital Status SSN DOB Place of Birth
Spouse's Name Spouse's Maiden Name
Place of Marriage Date of Marriage
Father's Name Mother's Name    
Mother's Maiden Name Years at Present Address
 Family
 
Sons: Location:
Daughters: Location:
Brothers: Location:
Sisters: Location:
Grandchildren: Location:
Great-grandchildren Location:
Great-great grandchildren: Location:
 Work/Education
Education (0-12) College (0-5+)
Occupation Business Company
Hobbies
 Military Record
Branch of Service Serial #
Date Enlisted Rank at Discharge
Copy of Discharge Papers Name of Wars
Funeral Service Information
Place Of Service:
Funeral Home:
Address:
Phone:
Place of Visitation:
Religious Denomination:
Place Of Worship:
Lodge / Union:
Person in Charge of Final Arrangements:
Special Instructions
Flower Preference:
Music
Casket Bearers (6):
Honorary Casket Bearers:

 
Jewelry:
Glasses:
Clothing:
Other:
Disposition Request
I Prefer:
Cemetery:
Address:
Phone:
Section:
Location:
I have made a last will and testament:    Yes    No
Other Instructions
Please list any other instructions you may have:
Memorials/Donations
Please list any Memorials or Donations to Charity that you would like (view partial list):
 Options
Please select one of the options below:
Send information about pre-arrangement
Contact me to set an appointment
Please keep my information on file
This is for a current funeral

 

After you submit your information, you will be returned to the Kidwell-Garber Home page.