Funeral Arrangement Information Form

We are very sorry for your loss and stand ready to assist you in your time of need. 

If you have not already scheduled a meeting with us, please call us.

You are welcome to send us information using the form below.  We understand that you may not have access to all of the details below (or would prefer to provide in person).  You are welcome to fill out as much or as little as you prefer.  We will cover the remainder when we meet with you or speak on the phone.

Funeral Arrangements Form

Decedents Last Permanent Address

Estimation is acceptable

If known

If Other or Multiple Choices, Please specify below

Job Title(s) Included
One per line.  Please include number of years worked with each.

i.e. (Masons, Lions Club, Knights of Columbus, etc..)

Please choose
Enter full date if known
Enter full date if known


Include Maiden Name (if applicable)
Needed for assisting us in contacting Social Security Office
If none, leave blank.

One per line
One per line
One per line
One per line
One per line
One per line
One per line

One per line

Information About You

If NO, please list below who is Next of Kin.

Your Contact Info  

There is no legal obligation as informant, only that you gave information for the Death Certificate.

Visitation / Calling Hours

When would you like visitation?

NOTE: Dates and times are tentative until scheduled directly with the funeral home and clergy.

Afternoon Hours
Evening Hours

Address of Church or Other Location for Visitation / Calling Hours

Main Funeral Service

Final Disposition

Cemetery Information

Many cemetery graves may be owned by one owner and used by other family members

Obituary (Optional)

Please select one or more

Include address or website if applicable

Word Document preferred
JPG or PNG preferred
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