Full Pre-Planning Form (for Someone Else) | Glunt Funeral Home and Crematory, Inc.

Information About Them (The person who this preplanning is for)

First Name

Middle Name

Last Name

Latest Permanent Address

Street

City

State/Province

ZIP/Postcode

Address within City/Borough limits?

YesNoUnknown

If No, which township?

Number of years at residenceEstimation is acceptable

Social Security #

Date of Birth

City and State of Birth

County of BirthIf known

Are they of Hispanic Origin?

YesNo

RaceIf Other or Multiple Choices, please specify below

Their Fathers Full Name(First, Middle, Last Name)

LivingDeceasedUnknown

Their Mothers Full Name (First, Middle, Maiden Name, Current Last Name)

LivingDeceasedUnknown

Marital Information

What is their Marital Status?

Information about their spouse (If applicable)

Spouses NameInclude Maiden Name (if applicable)

Date of Birth (Spouse)

Social Security Number (Spouse)Needed for assisting us in contacting Social Security Office

City and State of Birth (Spouse)

Education

Their Education Level

High School Attended

Year Graduated High School (If known)What year did they graduate high school (if applicable)

College(s) or University(ies) Attended

Education Notesie. When they graduated from college(s), degree specifications, etc..

Occupation

Usual Occupation (What job do/did they do most of the time?)Please included Job Title(s)

Are they Retired?

YesNo

Employer(s)One per line. Please include number of years worked with each.

Other Job Related Information

Military Information

Are they a Military Veteran?

Yes

No

If they are NOT a Veteran, is or was their spouse?

Yes

No

If neither they or their spouse are a military veterans, please skip to next section.

Do they have a copy of the Honorable Discharge (DD214)?

Yes

No

Unknown

If you can not locate a copy of the DD214, you can go to the military website and request them to do a search.

Please click HERE or copy the link below to your browser:

https://vetrecs.archives.gov/VeteranRequest/home.html

If you have the DD214 and can send us a copy (by mail or email) please skip to the next section.

Branch of Service

Rank when discharged

Wartime

Peacetime

Please choose

Served During?

Year Entered MilitaryEnter full date if known

Place Entered (City, State)Where they were inducted?

Year Released MilitaryEnter full date if known

Place Released from active dutyCity, State or Base released from:

Obituary (Optional)

Would they like to place an Obituary in a Newspaper?

Yes

No

Undecided

Depends on the cost

Newspaper Selection(s)

Erie Times News Free Notice

Erie Times News Paid Obituary (Paid by the line, average cost $350-$400)

West County Journal 75 flat rate Weekly Newspaper Publishes on Fridays

Corry Journal Paid Obituary

Other Newspapers Specify

Please select one or more

We would be happy to help write the obituary. If there is already an obituary written or someone is planning on writing it, please skip the hobbies and family members sections.

Memorial Donations Organization(s) for people to donate in memory of them.

Contributions / Donations may be made to:Include address or website of organization (if able to)

Family Members (Living and Deceased)

Please Include:

First and Last Name
Spouse (If applicable)
City and State they live in (If surviving)
Living or Deceased

SonsOne per line: (example: John Doe (Jane) of Edinboro, PA; or John Doe (Jane) - Deceased)

DaughtersOne per line: (example: Jayne Doe (Jack) of Edinboro, PA; or Jane Doe (Jack) - Deceased)

GrandchildrenOne per line: (example: John Doe (Jane);

Great-GrandchildrenOne per line: (example: John Doe (Jane);

BrothersOne per line: (example: John Doe (Jane) of Edinboro, PA)

SistersOne per line: (example: Jayne Doe (Jack) of Edinboro, PA)

Other Family / Special Friends that you would want to list.One per line

Additional instructions for us:About their final wishes, family members, comments, etc...

Questions that you may have:Please ask questions that you, or the person who this preneed is for, have so we can discuss.

Information About Them (The person who this preplanning is for)

Latest Permanent Address

Marital Information

Information about their spouse (If applicable)

Education

Occupation

Military Information

Obituary (Optional)

Memorial Donations Organization(s) for people to donate in memory of them.

Family Members (Living and Deceased)

Visitation / Calling Hours

When would they like visitation?

Funeral Service

Final Disposition

Your Information (Person filling out this form)