Pre-Planning Form

This document is presented as a guide to the information requested by your funeral director when arranging an at need or prearranged funeral. O'Brien-Straatmann will keep this form on file and can be provided to your family with proof of designation (family, next of kin or executor). Not all the fields are required to be filled out. This form should be printed and kept with your other important papers.

Biographical Information
Planning guide is for
Full Name:
E-Mail Address
Telephone Number including Area Code



Address:
Street
City
State
Zip
Resident Since
Citizen of (Country)



Place of Birth:
City
County
State
Zip
Date of Birth
Social Security Number



Parents:
Father
Place of Birth
Date of Birth
Mother (Maiden Name)
Place of Birth
Date of Birth



Family:
Marital Status
Spouse (Maiden Name)
Children Name Address Phone



Work History:
Occupation
Employed by
Retirement Date



Education:
Elementary
High School
College



Military Service:
Branch
Rank
Date of Enlistment
Date of Discharge
Location of Discharge
Serial Number



Funeral Preferences:
Type of Service
Visitation
Place of Service	Other
Conclude Service at	Other
Religious Denomination
Place of Worship
Type of Clergy
Type of Interment
Casket Type



Special Instructions
Music to be Played
Music to be Sung
Favorite Bible Passages
Literature or Poems
Flowers
Flower Color
Donations



Final Disposition:
Preference	Ground Interment with
	Mausoleum Entombment
	Cremation with
Cemetery Name
Cemetery Address



Finalizing Arrangements:
Do you have a will
Lawyers Name
Executors Name
Executors Address
Executors Phone Number
Executors E-mail Address
Executors Relationship to you



Relatives and Friends to Notify:
Name Relationship Address Phone

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Pre-Planning Form

Biographical Information