How to Pre-Plan Your Funeral

Simply complete as much of the information below as possible. The "Personal Information", "Work and Education History" and "Military Service" is often the most difficult information to obtain at the time funeral arrangements are being made. The information requested on this form is used for death certificate information, newspaper obituaries and to fulfill family wishes. This information will be kept on file at Horner-Lieske-Horner Mortuary and can be provided to your family when needed.

I am planning for
Personal Information
Full Name (First Middle Last):
 
Date of Birth: as (mm/dd/yyy) Place Of Birth:
Address:
City:  County:   State:   Zip:
Phone:   E-mail:
Spouse's Name:  
Spouse's Maiden Name:
Place of Marriage:   Date of Marriage: as (mm/dd/yyy)
Father's Name:

Mother's Name:

Mother's Maiden Name:

Employment/Education History
Education Level:

Primary:

   Secondary:
Occupation:
Business: Industry:
Company: # Of Years:

Military Service
Service Branch:
Date Enlisted: as (mm/dd/yyy)
Date Discharged: as (mm/dd/yyy) 
Rank At Discharge: 
Discharge On File At:
Name Of Wars:

Funeral Preferences
I Prefer My Funeral Service To Be
Place Of Service:
Conclude Service At:
Religious Denomination:
Place Of Worship:
Name:

Memorialization Instructions

Musical Selections
To Be Played
Will Supply CD/Tape

Musical Selections
To Be Sung
Favorite Bible Passages:
Favorite Literature Or Poems:
Favorite Flower(s):
Favorite Flower Color:

Final Disposition
Preference for final disposition is: Ground interment with
Mausoleum entombment
Cremation with
Preference of cemetery or mausoleum is:
Address:
A is owned at the above location

Special Instructions

Person To Finalize Arrangements At Time Of Death
Name:
Relationship:
Address:
City: State: Zip:
Phone: E-mail:

Send me information on pre-arrangement
Contact me to set an appointment
Keep my information on file

 

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