FUNERAL ARRANGEMENT WORKSHEET
NO.___________
NAME
AGE:
VITAL STATISTICS
ADDRESS
City-Town
State/Zip
County
Sex
:
M
F
Race-Ethnicity:
Citizen:
USA
BIRTHPLACE
DATE OF BIRTH
Father's Name
His Birthplace
Mother's Maiden Name
Her Birthplace
MARITAL STATUS
Surviving Spouse
Date & Place of Marriage
EMPLOYMENT STATUS:
Retired
(Year
)
Presently Employed
Not Employed
Usual Occupation
Kind of Business
Employer
No. of Years
Social Security No.
Highest Education
VETERAN:
No
Yes
Branch of Service
Rank
Service Dates
to
Service No.
Honors - Commendations
INFORMANT'S NAME
Informant's Address
Informant's Phone
Relationship
BIOGRAPHICAL INFORMATION
Length of time living in this area:
Moved from
Religion
Member
Attended
Non Member
Church/Synagogue
City
Clubs, Organizations, Other Information:
Preceded in Death by (Spouse's Name)
Year
SURVIVORS
Spouse
Parent(s)
/Children
/Sisters
/Brothers
/Grandchidren
Great /Great Grandchidren
/Great-Great Grandchildren
Other Survivors:
VISITATION
Day
Day
Day
Day
Day
Day
Day
Day
CASKET OPENED:
For Family & Friends
Family Only
No Viewing for Anyone
ROOM:
SPECIAL SET UP:
Catholic
Other
Rosary
Wake
FUNERAL SERVICES
Traditional Funeral
Mass
Graveside Service
Memorial Service
DAY-DATE
HOUR
PLACE
CLERGY
MUSIC:
Standard
Special Selections
Organist
Soloist
FAMILY WILL SIT IN
Family Room
Chapel
No. of Reserved Seats
NO. OF FAMILY CARS:
Address:
Pickup Time
Address:
Pickup Time
When will casket be closed?
Jewelry, etc. to remove for family:
PALLBEARERS:
Professional
Selected by Family
We notify
Family Notifies
Honorary Pallbearers
Escort
COMMITTAL SERVICE:
Immediately Following
Flowers Accepted
In lieu of flowers, memorials to:
FINAL DISPOSITION
INTERMENT
ENTOMBMENT
CREMATION
DAY-DATE
HOUR
Cemetery/Crematory
City-Town
State/Zip
County
Grave No.
Lot
Section
Block
Lot Owner
Lot Purchased:
Pre-Need
At-Need
Outer Container/Vault Provided by:
Marker
Disposition of Cremated Remains
ADDITIONAL INFORMATION
Newspaper Notices in:
Flowers to order
Hairstyling
Jewelry
Glasses
Clothing
Other
DATE REQUESTED
CERTIFIED COPIES FOR
QUAN
.
COMPLETED